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Customer Intake Form
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1
What type of business are you?
Retail (C-Store, Gas Station, Liquor Store, Smoke Shop, Coffee/Doughnut Shop, etc.)
Distribution (must have a wholesale/distribution license)
Unsure. Please contact me!
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2
How would you like to receive your purchases?
Cash & Carry (In person shopping/Pick-Up)
Delivery
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3
Name
First Name
Last Name
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4
Email
example@example.com
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5
Phone Number
Please enter a valid phone number.
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6
Company Name
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7
Where did you hear about us?
Google, Trade Show, Referral, etc.
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