Custom Gummy Form
Minimum Order Quantity (MOQ) / R&D Fees for Gummies
MOQ $150,000 Gummies / R&D $1,500
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
JAG Rep Name
*
Please Select
Barbara Hines
Casey File
David Whitmer
Dennis Collard
Ellen/Scott Struber
Heidi Simon
JAG (Unlisted or Unknown)
Kaitlin Schmidt
Lena Akerman
Marzena Jonak
Sherrell Gilmore
Travis Keziah
Billing Information
Company Name
*
Company Website
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Product Information
Target Price (this is the price you are wanting us to formulate to. Not your retail price)
*
Target Launch Date
-
Month
-
Day
Year
Date
Ingredients
Note: If customer is providing Active Ingredients, please provide COA with Lab Testing to match order form selection below. All shipments arriving will also need a packing slip with all containers properly labeled with Lot's #, tare weights, and net weights.
Please include all ingredients required AND specify amount of mg of each ingredient per gummy.
*
Are any of the ingredients being provided by the client? If yes please list each of the ingredients.
*
Ingredients or types of ingredients to avoid when formulating?
*
Is there an existing product that you would like to use as a benchmark?
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Gummy Details
Gummy Size
*
2.5 gram
3.0 gram
3.5 gram
4.0 gram
4.5 gram
5.0 gram
Flavors
*
Gummy color/s
*
If this product Contains CBD please list the type of CBD and mg per gummy
*
Packaging Options
Bulk Packaging
*
Yes, skip bottle selection
No, proceed to bottle selection
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Bottling Selection
Bottle Type
*
HDPE
PET
Other
Bottle Size
*
60cc
75cc
100cc
120cc
150cc
200cc
250cc
300cc
400cc
Other
Bottle Color
*
White
Black
Clear
Other
Cap Type
*
Smooth
Ribbed
Child Resistant
Other
Cap Liner
*
Pressure
Heat Induction
Other
Tamper Proof/Neck Band
*
Clear/perforated
Other
Label
*
Label
No label
Other
Total Bottles Needed
*
Number of Gummies per Bottle
*
Packaging
*
Single Carton POP Box
No Single Carton POP Box
Custom POP Box
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Custom POP Box
If you chose Custom POP box please specify details here
*
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Master Cases
Master Cases (shipper boxes)
*
Master cases needed
Master cases not needed
Other
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Master Cases Information
If master cases are needed please specify details here. Please note information needed on box label: i.e., Lot #, Product #, Product name
*
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Gummies Quantities
Total Number of Gummies needed (minimum order is 150,000)
*
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Shipping
Shipping Details
*
LTL (palletized)
UPS/FEDEX/USPS
Other
Company Name & Shipping Contact Name
*
Who do we address the shipment to?
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Contact Phone Number
*
Please enter a valid phone number.
Shipping Contact Email
*
example@example.com
Shipping Hours
*
Lift Gate Needed
*
Yes
No
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Lab Testing
Lab Testing Requirements
*
Potency Only
Mycotoxins Only
Microbials Only
Heavy Metals Only
Residual Solvents Only
Pesticides Only
Full Panel (ALL OF THE ABOVE)
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Notes
Please provide any additional details you wish to share with our formulation team.
Upload any documents, packaging or POP images
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