MARISA FOODS

Internal Use — Filled Out by Michael

Sample Fulfillment Form

Submitting this form moves this order to Sample Sent / Fulfilled on the pipeline and notifies Don and Marissa.

1. Order Reference

Customer Email *

Please use the same email when the sample product was requested

Order/Reference Number (if applicable)

2. Items Fulfilled

List each item that was actually packed and sent. Match against the original Sample Request — note any substitutions in Section 5.

Items / Products Fulfilled

Items Fulfilled

3. Delivery Method

How was this sample sent?

Mailed / Shipped

Customer Pickup

Local Delivery

Hand-Delivered by Rep

Tracking Number *

4. Date Fulfilled

Date the sample was packed, shipped, or handed off *

5. Notes for Don / Marissa

Optional — substitutions made, packaging issues, delays, or anything else they should know.

Notes for Don / Marisa