Karihome Sample Request

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Karihome Sample Request

Hi there, please fill out this form to redeem free Karihome samples.

18Questions

1
Sent from website?
2
Please choose the sample sachet you wish to receive* This field is required.
3
Please choose additional sample sachetWill require additional child details
4
Do you need third additional sample sachet?Will require 3rd additional child details
5
You have requested for Growing-up sachet.Our Growing-up sachets are currently out of stock. Please send in your request and we'll notify you as soon as our stock is replenished. Thank you for your understanding.
OK
6
How did you find out about us?* This field is required.
Facebook/Instagram
Magazines
Event/Workshop
Email
Word of mouth
Brochure
Forum
Video Ads (Digital or TV)
Promoter
Online ads
Recommendation from medical professional
Other
7
Please tell us which Other platform you found Karihome
8
Please Tell Us Your Name* This field is required.
First Name
Last Name
9
Your age* This field is required.
Below 24
25 - 34
35 - 44
45 - 54
Above 55
10
Your NRIC/FIN No.We'll only use this to check for duplicate requests. Nothing else.
11
Your Address* This field is required.
12
Your Contact Number* This field is required.
13
Your Email* This field is required.
14
Your child's current brand of milk* This field is required.You can select more than one.
Breast Milk
Karihome
Abbott
Mead Johnson
Dumex / Dugro
Nestle
Friso
Wyeth
Aptamil
Bellamy
Australia’s Own
Nature One Dairy
15
Your child's name* This field is required.
First Name
Last Name
16
Your child's birth date* This field is required.
Date
Year
Month
Day
17
Your 2nd child's name* This field is required.
First Name
Last Name
18
Your 2nd child's birth date* This field is required.
Date
Year
Month
Day
19
Your 3rd child's name* This field is required.
First Name
Last Name
20
Your 3rd child's birth date* This field is required.
Date
Year
Month
Day
21
Remarks
22
Terms* This field is required.By proceeding, you accept and agree to all future contact from Orient EuroPharma Pte Ltd.. Please allow 4-6 weeks for delivery. Only completed entries will be processed. Limited to one set of samples per household & for first time users only. Applicable to Karihome Follow-Up and Growing-Up formulas. Strictly no sampling of Karihome Infant Formula (for babies 0-6 months old). All information provided is used solely by the program and will not be rented, sold or exchanged with outside parties.
I accept
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