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Custom Gummy Form
Minimum Order Quantity (MOQ) / R&D Fees for Gummies

MOQ 150,000 Gummies / R&D $1,500
Date*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
CBDHE Rep Name*
Billing Information
Company Name*
Company Website*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Product Information
Target Price (this is the price you are wanting to pay per a gummy not your retail price)*
Target Launch Date

MonthDayYear
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?

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*

Lab Testing
Lab Testing Requirements*

Potency OnlyMycotoxins OnlyMicrobials OnlyHeavy Metals OnlyResidual Solvents OnlyPesticides OnlyFull Panel (ALL OF THE ABOVE)

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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Custom Gummy Form