Current Clients

Free Sample(s) - Eligibility Form

MEGAComfort is pleased to provide free samples to select Health and Safety Personnel.

Eligibility is at the sole discretion of MEGAComfort

First Name :
Last Name :
Address :
City :
Country :
Province / State :
Zip / postal Code :
Company :
Number of locations :
Number of employees at your location :
Telephone :	Ext
E-mail Address :
Does your company presently use anti-fatigue floor matting ? :	Yes No
-- If yes , how much is your annual matting budget ? :
Do you have a preferred footwear or safety product distributor ? :	Yes No
-- If yes, who is the distributor ? :
Does your company presently have a safety footwear program in place ? :	Yes No
-- If yes, how much is paid for by the company ? :
-- If yes, how is the re-imbursement done ? :
Does your company presently provide insoles/orthotics ? :	Yes No
-- If yes, which brand and type ? :
-- If yes, how much is paid for by the company ? :
-- If yes, how is the re-imbursement done ? :
What benefits form flooring matting or shoe insoles and orthotics are you most interested in achieving ? (Please check all that apply) :	Decreased Worker Fatigue Safer Alternative to Matting More Cost Effective Alternative to Matting Cover Areas Where Matting Can't Be Used Increased Worker Comfort Increased Worker Productivity
Has your company ever conducted an evaluation program in regards to floor matting, insoles/orthotics and worker comfort and fatigue ? :	Yes No
Size Requests : Preferred Size (we will try our best to accommodate) :
Other Special Requests or Relevant Information :

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