Retail Order

Account Info
Business Name*
Order Type*
- Reorder
- First Order: New Store + Set-up
Any Changes to Account Information?*
- Yes
- No
Contact Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Billing Information Same as Above?*
- Yes
- No
Entity Name*
Billing Contact*
First Last
Billing Phone*
Email*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Products
NUKES - Cool Mint 4mg (Roll) Quantity
Suggested Retail: $6.99 | 10-cans /roll
$42.00
Price: $42.00
NUKES - Cool Mint 8mg (Roll) Quantity
Suggested Retail: $6.99 | 10-cans /roll
$42.00
Price: $42.00
NUKES - Watermelon 4mg (Roll) Quantity
Suggested Retail: $6.99 | 10-cans /roll
$42.00
Price: $42.00
NUKES - Watermelon 8mg (Roll) Quantity
Suggested Retail: $6.99 | 10-cans /roll
$42.00
Price: $42.00
Displays & Accessories
Retail Dispensers Quantity
$30.00
Price: $30.00
Premium Metal NUKES Holder Quantity
Suggested Retail: $24.99
Price: $15.00
Total
Total
$0.00
Please Note: Orders under $200 will see an additional $10 shipping charge.
Additional Comments
Comments
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Account Info