Abstract: The invention relates a combined sample dispenser and order form comprising a backing sheet that may be prepared from cardboard and a generally planar retaining member, such as a clear plastic sheet, attached to the backing sheet along at least a portion thereof. The retaining member or plastic sheet defines a distention or pocket along a portion of its broad surface, that may contain samples of the product being dispensed, such as sample medications provided to physicians by pharmaceutical manufacturers. The invention is also useful for the sale of certain consumable items, including hardware, where the order form may be used by the consumer to directly request additional quantities of the product.

Abstract: The invention relates a combined sample dispenser and order form comprising a backing sheet that may be prepared from cardboard, and a generally planar retaining member, such as a clear plastic sheet, attached to the backing sheet along at least a portion thereof. The retaining member or plastic sheet defines a distention or pocket along a portion of its broad surface, that may contain samples of the product being dispensed, such as sample medications provided to physicians by pharmaceutical manufacturers. The invention is also useful for the sale of certain consumable items, including hardware, where the order form may be used by the consumer to directly request additional quantities of the product.