www.UltraBalm.com

Friday, 24 May 2013

Wholesale Order Form

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* Required information.

If you're a Retail Outlet or an individual who wishes to purchase our products by the case, NO APPLICATION is necessary.

Please fill out this form completely. Fields with a (*) are required.
Date: *
Store/Company Name:
Authorized Buyer: *
Referred By (If Any):
Phone Number: *
Fax Number:
Email Address: *
Website Address:
Type of Outlet: *

Ship To Address
Ship To Name: *
Street Address: *
City: *
State: *
Zip Code: *

Order Details
Selected Original Citrus Scented or Unscented: *
Select # of Cases of Jars: *
Select # of Cases of Tubes: *

Shipping & Handling is NOT INCLUDED in the Above Prices
All Wholesale orders are shipped UPS Ground.

ORDER 50 CASES OF ANY MIX & GET FREE SHIPPING!

Suggested retail price is $39.95 per Jar & $15.00 per Tube.

(Wholesale unit costs: $19.95 per jar & $7.99 per tube. 12 each per case.)

Point Of Sale Promotion Request
(For Retail Outlets Only)
(Please check all you wish to receive.)

 
Requested Items:
Counter Table Tent
Window Sign 8.5 x 11
Wall Sign 8.5 x 11
Additional Comments:

Payment Information
Payment Method: *
Visa
Mastercard
Amex
Discover
Credit Card Billing Name: *
Credit Card #: *
Expiration Date: *
CVV: *
Billing Zip Code: *
Tax Exempt Resale Number:

**Please Note: Without a resale certificate number on file you will be charged tax
when ordering from Florida in addition on your order.