BBCo. Wholesale/Catering App

1

Business Name* This field is required.

2

Contact Name* This field is required.

First Name

Last Name

3

Contact Email Address* This field is required.

example@example.com

4

Contact Phone Number* This field is required.

Area Code

Phone Number

5

Business Address (Shipping Location)* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

7

Do you currently carry other non-alcoholic beverages or functional drinks?* This field is required.

YESNO

8

If "yes" - which brands?

9

Briefly tell us why you are interested in carrying Blessed Beverage Co.* This field is required.

11

If "other" - tell us how you heard about us.

12

Estimated Monthly Case Volume (12-Pack Cases)* This field is required.Current Wholesale Pricing for 12-Pack = Discounted at 20% from $54 to $43.20

1-5

6-10

11+

13

Would you like to purchase 4-Pack boxes to sell Sunshine Revival in 4-Pack units?* This field is required.+$1.50 each

YESNO

14

Preferred Payment Method* This field is required.

Cash

Credit Card

Zelle / Venmo

PayPal

15

If you have any questions or comments, feel free to ask them here!