Custom Topical Form
Minimum Order Quantity (MOQ) / R&D Fees for Topicals
MOQ 5,000 Topicals / 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
CBDHE 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
Topical Details
Target Price (this is the price you are wanting to pay per unit not your retail price)
*
Target Launch Date
-
Month
-
Day
Year
Date
Type of Product Desired
*
Is there an existing product that you would like to use as a benchmark?
Intended area of the body for the product? If necessary please include skin type or hair type to target.
*
Scent of product (fragrance or essential oils only?)
*
Please include all ingredients required AND specify amount of mg of each ingredient per topical. If unsure our formulators can make recommendations.
*
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.
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?
*
If this product contains CBD please list the type of CBD and mg per topical.
*
Appearance & feel of product (color, texture, thickness)
*
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Packaging Selection
Packaging
*
Bottle
Jar
Tube
Airless
Other
Packaging Fill Size
*
1oz
2oz
4oz
8oz
Other
Dispenser Type
*
Disc Cap
Lotion Pump
Treatment Pump
Sprayer
Dropper
Other
Desired Label Claims
*
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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Topical Quantities
Total Number of Topicals needed (minimum order is 5,000 units)
*
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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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