Please complete this form and get your free
size sample
Name:
Your Baby's Name:
Your Baby's Age:
--Select your baby age--
Less than 2 months
3 to 6 months
7 to 12 months
1 year +
Baby's Current Weight:
--Select your baby weight--
Upto 3 kgs
4 - 8 kgs
9+ kgs
Shipping Address:
State:
---Select State---
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
New Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Pin Code:
Telephone:
Mobile:
We might need to call you for confirmation of the shipping address.
E-mail:
Current Diaper Brand used
I do not use any disposable diapers
Mamy Poko Pants
Pampers Active Baby Pants
Huggies Dry Pants
Huggies Dry Comfort
Pampers Green
Pampers Active Baby
Huggies Care
Others
How did you come to know about MamyPoko Pants S size Free Sampling
Mother & Baby Magazine
Google
Facebook
Friends & Relatives
Yahoo
Others
Are you sure you want a S size(4 to 8 kgs) diaper sample for your baby?
Yes
No, my baby will fit into
M size (7 to 12 Kgs)
L size (9 to 14 Kgs)
XL size (12 to 17 Kgs)
I agree to
Terms & Conditions
and to receive product samples on my postal address.
I agree to receive promotional messages on email or mobile or direct mail from Unicharm India Pvt Ltd.
Enter the text above
Letters are not case sensitive
Note:
Free Diaper Sample is available for shipment in India only.
size sample
size sample