Wholesale Orders

Company Information:

Company Name*:

Contact Name*:

Position/Title:

Phone Number*:

Email Address*:

Billing Address*:

Shipping Address (if different from Billing Address):

Preferred Method of Contact:

Email Phone Other

New Customer Setup (for A/R and CRM Database):

Type of Business*:

Business License Number:

Tax ID Number*:

Accounts Payable Contact*:

A/P Contact Email*:

A/P Contact Phone Number:

Primary Contact for Order Inquiries*:

Order Inquiry Contact Email:

Order Inquiry Contact Phone Number:

Order Information:

Product Description: 12-pack cases of Bored & Thirsty Water

Quantity of 12-pack Cases*:

Delivery Location(s)*:

If multiple locations, please email a location list to: albert@boredandthirsty.com.

Trade Show Promotional Offer:

Promotion Code:

Offer Details:

Please confirm the promotional offer negotiated at the trade show for your initial order with: albert@boredandthirsty.com

Billing Information:

Responsible Billing Party*:

Billing Party Contact Name*:

Billing Party Phone Number*:

Billing Party Email Address*:

Preferred Payment Method:

Credit Card Bank Transfer Check

If Credit Card, a secure link/form will be sent for payment information.
For Bank Transfers, banking details will be provided on the invoice.
For Checks, please mail to the Billing Address: Attention A/R Dept - Bored & Thirsty, 724 N Poinsettia Street, Suite #2, Santa Ana CA 92701

Special Instructions/Notes:

Confirmation:

By signing below, I confirm that the information provided on this order form is accurate and authorize Boredroom, LLC to process this order as per the terms discussed. I understand that an invoice will be issued to the Responsible Billing Party, and payment will be due according to the terms specified in the invoice.

Authorized Signature*:

Print Name*:

Date*:

Wholesale Order Form