Special Product Request
Please fill out the following info. We will do our research and get back with you asap. For any questions contact specialorders@brownbagliquor.com or give us a call at 913-764-0816
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Preferred Form of Contact:
Phone
Text
Product Category
*
Please Select
Wine
Spirits
Beer
Non-Alcoholic
Cigars
Product Requested
*
Product Size
*
Requested Quantity
*
Case(s) or Bottle(s)
*
Case(s)
Bottles(s)
Beer is available by case only:
*
Enter case quantity above
Stock Options
*
Please Select
One Time Order
Stock on Shelf
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of
Would you like to request an additional product?
Yes
Product Requested #2
*
Product Size #2
*
Product Category #2
*
Please Select
Wine
Spirits
Beer
Non-Alcoholic
Cigars
Requested Quantity #2
*
Case or Bottle(s) #2
*
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of
Pricing Options
*
Please Select
Send pricing
Order without notification
Submitted by:
Customer
Employee
Notes:
Any additional information
Employee Name:
Ordered by:
Ordered on:
-
Month
-
Day
Year
Date
Notes to relay to customer:
Contacted customer:
Date
-
Month
-
Day
Year
Date
Contact:
Spoke with on phone
Texted
Left Voicemail
Submit
Should be Empty: