Request for a Sample

  Mrs.   Mr.   Dr.   Prof.

Leer

Please make sure to put in at least all fields indicated with an asterisk (*). Immediately after submitting the form, you will receive an automated email summarizing all the details. We will send you a personalized email as soon as possible to confirm your shipping address and provide you with the necessary instructions for using our products.

  I agree that my personal details will be stored and processed at Active Bioscience GmbH. Please see our privacy policy.

  The samples may not be transferred or sold to third parties or used for clinical purposes.

  I am prepared to provide Active Bioscience with feedback on the evaluation of the samples within three months of receiving them.

  I agree to participate in an online meeting to receive detailed product information and important usage instructions before receiving the samples.

Your personal information will be used solely for the purpose of sending you the samples. Your data will be used solely by Active Bioscience.

Please select at least one sample from the list above to submit your request.