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Beautycounter Sample Form
Please fill out this form completely and I will send you samples that fit your skin type the best. You can't currently be working with another consultant.
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Email
*
Your email
What is your full name?
Your answer
What is your mailing address? Include City, State, Zip
*
Your answer
What is your phone number (for text messages)
Your answer
What is your skin type?
Dry skin
Normal Skin
Oily Skin
Combination Skin
Acne Prone
Mature Skin
Have you shopped with Beautycounter before?
*
No, I am new to Beautycounter
Yes, but I haven't purchased in a long time and don't have a consultant
Yes, I buy from HQ and not a consultant
Yes, I shop with another consultant and love her!
I shop with Dr. Meghan as my consultant
Required
What samples are you the most interested in trying?
*
Countertime
Countermatch
Countercontrol
Counterman
Overnight Resurfacing Peel
Cleansing Balm
Countersun Sunscreen lotion
All Bright C Serum
Skin Twin
Required
If you are choosing a Skin Twin Sample I want to color match you the best I can. Please include the color of your wrist veins (purple, blue, green) and what shade you think you are: Fair, Light, Medium, Tan, Dark, or Deep.
Your answer
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