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*Company Name:
*Contact Name:
Address:
Zip/Postal Code:
Country:
*Phone:
Fax:
*E-Mail:
Product Name:
Initial Order Volume:
Estimated Annual Volume:
Type Of Product:
Capsule
Tablet
Soft Gel
Veggie Capsule
Powder
Liquid
Chewables
Product Size (If Applicable):
Tablet Punch Size:
Capsule Size:
00
0
1
2
Product formula or list of ingredients:
Bottle Size:
Bottle Shape:
Bottle Material:
Plastic
HDPE
PET
Glass
Capsule Type:
Regular
Hinged
CRC
Capsule/Tablet Count Per Bottle
YES
NO
Cotton/Rayon
Desiccant
Induction Seal
Neck Band
Unit Carton
Saftey Seal On Unit Carton
Insert (Card or other marketing material)
Unit Tray
Shrink Bundle of Bottles/Unit Cartons
Comments:
