Wholesale Order Form

ORDER FORM WHOLESALE/DISTRIBUTOR

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Store Name *Please fill the required field.

Contact Name *Please fill the required field.

AddressPlease fill the required field.

Phone *Please fill the required field.

Today's Date *Please fill the required field.

Email *Please fill the required field.

Is this a rushed order? *

Yes

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If this is a rushed order, what is your preferred delivery dates/time:

ORDER BY THE CASE WHOLESALE/DISTRIBUTORS)

Flores Michelada Mix Bottle 12/32oz per case. Item#01960

Flores GummyOh's Con Chile 20/8oz Bags per case. Item#02025

Flores Crawlers Con Chile 20/8oz Bags per case. Item#02024

Flores Mango Con Chile 20/8oz Bags per case. Item#02026

Flores Watermelon Slices con Chile 20/8oz Bags per case. Item#02027

FLORES VARIETY RIMMING DIPS

Flores Rimming Dip Mixed Case 24ct (4 of each flavor)

Flores Spicy Mango Rimming Dip 24ct per case. Item#02031

Flores Tamarindo Rimming Dip 24ct per case. Item#02035

Flores Spicy Strawberry Rimming Dip 24ct per case. Item#02036

Flores Spicy Peach Rimming Dip 24ct per case. Item#02036

Flores Spicy Watermelon Rimming Dip 24ct per case. Item#02032

Flores Spicy Pineapple Rimming Dip 24ct per case. Item#02034

Flores Tamarindo Rimming Dip. Item#01950

ORDER BY THE PIECE (WHOLESALE/STORES ONLY)

Flores Spicy Mango Rimming Dip Item#01946

Flores Spicy Peach Rimming Dip Item#01999

Flores Spicy Strawberry Rimming Dip Item#01948

Flores Spicy Watermelon Rimming Dip Item#01947

Flores Spicy Pineapple Rimming Dip Item#01949

Preferred Method of Receiving Confirmation & Delivery Information *

Text

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Special Structions

Invoice type preference *

Emailed

Hard copy

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<h1> </h1>
<table class="table" style="width: 100%; height: auto;">
<tbody>
<tr>
<td><img src="https://www.floresmicheladas.com/images/Flores_Logo.png" alt="" width="167" height="92" /></td>
<td style="text-align: right;"> </td>
<td style="text-align: right;">
<h1>ORDER FORM</h1>
</td>
</tr>
<tr>
<td> </td>
<td> </td>
<td style="text-align: right;">
<p><strong>Date:</strong> {{date}}</p>
<p> </p>
</td>
</tr>
<tr>
<td> </td>
<td style="padding-left: 30px;">
<h3><strong>FROM</strong></h3>
</td>
<td> </td>
</tr>
<tr>
<td> </td>
<td style="padding-left: 30px;"><strong>Store Name:</strong></td>
<td style="padding-left: 30px;"> {{store-name}}</td>
</tr>
<tr>
<td> </td>
<td style="padding-left: 30px;"><strong>Contact Name:</strong></td>
<td style="padding-left: 30px;"> {{full-name}}</td>
</tr>
<tr>
<td> </td>
<td style="padding-left: 30px;"><strong>Address:</strong></td>
<td style="padding-left: 30px;">{{address}}</td>
</tr>
<tr>
<td> </td>
<td style="padding-left: 30px;"><strong>Email:</strong></td>
<td style="padding-left: 30px;"> {{email}}</td>
</tr>
<tr>
<td> <strong>Rushed:</strong> {{rushed}}  {{rushed-info}}</td>
<td style="padding-left: 30px;"><strong>Phone:</strong></td>
<td style="padding-left: 30px;"> {{phone}}</td>
</tr>
</tbody>
</table>
<p> </p>
<table class="table" style="width: 100%; height: auto; border-color: #dddddd;" border="1" cellspacing="0" cellpadding="0">
<thead>
<tr style="background-color: #ebebeb; height: 70px;">
<th style="width: 10%; text-align: center; vertical-align: middle;" valign="bottom">ITEM # </th>
<th style="width: 70%; text-align: center; vertical-align: middle;" valign="bottom">
<p style="text-align: center;" align="center">ITEM DESCRIPTION</p>
</th>
<th style="width: 10%; text-align: center; vertical-align: middle;" valign="bottom">Q Case </th>
<th style="width: 10%; text-align: center; vertical-align: middle;" valign="bottom">Q Unit</th>
</tr>
</thead>
<tbody>
<tr style="height: 50px;">
<td style="width: 50px; height: 50px; text-align: center; vertical-align: middle;" valign="bottom">
<p align="center">01960</p>
</td>
<td style="text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Michelada Mix Bottle 12/32oz per Case</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{michelada-mix}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
<tr style="height: 50px;">
<td style="width: 50px; height: 50px; text-align: center; vertical-align: middle;" valign="bottom">
<p align="center">02024</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Crawlers Con Chile 20/8oz Bags per Case</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{crawlers}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
<tr style="height: 50px;">
<td style="width: 50px; height: 50px; text-align: center; vertical-align: middle;" valign="bottom">
<p align="center">02025</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores GummyOh's Con Chile 20/8oz Bags per Case</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{gummyoh}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
<tr style="height: 50px;">
<td style="width: 50px; height: 50px; text-align: center; vertical-align: middle;" valign="bottom">
<p align="center">02026</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Mango Con Chile 20/8oz Bags per Case</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{mango-con-chile}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">02027</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Watermelon Slices con Chile 20/8oz Bags per Case</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{watermelon-con-chile}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="middle">
<p align="center"><strong>Most Popular </strong><strong>Option</strong></p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="middle">
<p style="text-align: left;" align="center">  Flores Rimming Dip Mixed Case 24ct (4 of each flavor)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p>{{dip-mixed-case}} </p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">01946</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Spicy Mango Rimming Dip (24ct per Case)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{spicy-mango-dip}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">{{spicy-mango-dip-p}} </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">01950</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Tamarindo Rimming Dip (24ct per Case)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{tamarindo-dip}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">{{tamarindo-dip-p}} </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">01999</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Spicy Peach Rimming Dip (24ct per Case)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{spicy-peach-dip}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">{{spicy-peach-dip-p}} </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">01948</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Spicy Strawberry Rimming Dip (24ct per Case)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{spicy-strawberry-dip}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">{{spicy-strawberry-dip-p}} </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">01947</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Spicy Watermelon Rimming Dip (24ct per Case)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{spicy-watermelon-dip}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">{{spicy-watermelon-dip-p}} </td>
</tr>
<tr style="height: 50px;">
<td style="height: 50px; text-align: center; vertical-align: middle; width: 50px;" valign="bottom">
<p align="center">01949</p>
</td>
<td style="width: 70%; text-align: left; vertical-align: middle; height: 60px;" valign="bottom">
<p style="text-align: left;" align="center">  Flores Spicy Pineapple Rimming Dip (24ct per Case)</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom">
<p> {{spicy-pineapple-dip}}</p>
</td>
<td style="width: 155px; text-align: center; vertical-align: middle;" valign="bottom"> </td>
</tr>
</tbody>
</table>
<p><strong>Special Instructions:</strong> {{special-instructions}} </p>
<p><strong>Prefer method of contact:</strong> {{contact-method}}</p>
<p><strong>Prefer invoice type:</strong> {{invoice}}</p>
<p>__</p>
<p><strong>Flores Team</strong></p>
<p> </p>

Note:

Note: Once your order is received, a representative will email or text you a confirmation and delivery date information. You will also receive a copy of your order for your records.

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