Disinfect & Fog Agent Form - Purchasing SaniGO Wrist Bands
Complete the form below, and we will invoice the client.
AGENT Name: *
AGENT Email: *
Client Business name:
Client name: *
Client Email: *
Client Phone number: *
Client Shipping Address: *
Client City, Province, Country: *
Client Postal code: *
Type of Business: *
Select one...
Automotive
Business
Child Care
Community Centre
Dental
Education
Entertainment
Funeral Home
Government
Healthcare
Hospitality
Industrial
Place of Worship
Real Estate
Sports + Recreation
Transportation
Tourism
Travel
Veterinarian + Animal Care
Other
If other, enter Below:
Payment method: *
Select one...
Credit Card
Cheque
E-Transfer
Client Billing Address (if different from shipping address):
Quantity : *
Colour(s) (if multiple, type in box below how many of each): *
White
Transparent Clear
Black
Grey
Transparent Grey
Red
Pink
Transparent Pink
Deep Purple
Purple
Light Purple
Transparent Green
Yellow
Light Blue
Transparent Blue
Branded (does the client want their logo added)? *
Select one...
Yes
No
Pricing discussed with client: *
Additional information (optional):
Thank you!
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