Legal Name of Company * (Retailer, Broker, Brand, Manufacturer etc) Business Type Retailer Distributor Broker Business Other Contact Name * First Name Last Name Contact Email * Phone Number optional (###) ### #### Billing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Accounting Email Where to send invoices. Payables Email Payment follow up. Place an order Make sure to have the contact sign the form!! amounts specified in order form 5+1 Cylinders 3+1 Cylinders Waterbottles case Machines case Order Through Distributor Delivery Address Street Number & Name, City, Postal code, Province, Country Reason for Connecting * Listing Collaboration Inquiries Connect Reorder Comments or notable points of our conversation today. Don't click Submit. Hand device back to our team:) Team Notes * Indigo Soda Team notes to remember interaction. Language English French Other PST # If Applicable. Thank you!
