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Please DONOT enter credit card information or any account info on this form. Fill out the form completly, print out 2 copies, mail one along with your check or M.O. (Frequently Asked Questions about wholesale click here) [main page] Person to Contact Address City,State,Zip Phone Fax We must have your tax ID # on file please make a copy and send with order or fax 423-379-2396 Tax ID Number Special Instructions Comments Enter the quantity in the box to the right of each jug you wish to order. Leave the other boxs empty. All shipping charges are your responsibility!. 3 Tier Jug $10.00
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