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THIS FORM IS FOR INTERNAL USE ONLY. WE DO NOT SELL DIRECTLY TO THE PUBLIC. 

Is this a time sensitive or special conditions order? *

Yes

No

Additional Comments for Time Sensitive/Special Conditions Order

PO# *

Requested Delivery Date (ex: between May 1- May 4) *

Preferred 4 hour Delivery Window *

Person placing the order, where the delivery needs to go and who will receive the product on-site.

What's your name? *

Abby Peck Anna Delgado Armando Alcantara Arturo Cruz Bean Worley Cambrey Weiman Courtney McNair Daniel Matson David de la Garza Diana Aranda Edgar Garza Fermin Cantu Giovanni Gallucci Juan Martinez Kim Weber Leo Gonzalez Lo Gamez Melissa Cerda-Richards Molly Vimini Natalie Barajas Patricia Lopez-Garcia Sam Nord-Stevens Steven Morales Taylor McNair Ted Mackey Yuri Acosta

What's your email address? *

12PK GLASS - 12OZ ORIGINAL (930) (120 cases per pallet)

4PK Glass - 12OZ ORIGINAL (3354) (60 cases per pallet)

24PK GLASS - 12OZ ORIGINAL (928) (60 cases per pallet)

24PK GLASS - 6.5OZ ORIGINAL (927) (90 cases per pallet)

18PK GLASS - 16.9OZ ORIGINAL (14192) (60 cases per pallet)

24PK PET - 20OZ ORIGINAL (903) (54 cases per pallet)

12PK GLASS - 25.4 ORIGINAL (1474) (56 cases per pallet)

8PK PET – 1.5L ORIGINAL (918) (60 cases per pallet)

24PK GLASS - 12OZ TWIST OF GRAPEFRUIT (3359) (60 cases per pallet)

4PK Glass - 12OZ TWIST OF GRAPEFRUIT (3357) (60 cases per pallet)

24PK PET - 20OZ TWIST OF GRAPEFRUIT (8258) (54 cases per pallet)

24PK GLASS - 12OZ TWIST OF LIME (920) (60 cases per pallet)

4PK Glass - 12OZ TWIST OF LIME (3355) (60 cases per pallet)

24PK PET - 20OZ TWIST OF LIME (8257) (54 cases per pallet)

4PK Glass - 12OZ TWIST OF TANGERINE (14282) (60 cases per pallet)

24PK GLASS - 12OZ TWIST OF TANGERINE (14281) (60 cases per pallet)

ex: El Cosmico, Attn: Yeah Field Trip, 802 S. Highland Ave., Marfa, TX 79843

Ship To Name (Business/Company): *

ex: El Cosmico

Ship To Attn (Event name or person’s full name): *

ex: Attn: Yeah Field Trip Your answer

Address *

Address Line 1

Address Line 2

City

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands (US) Virginia Washington West Virginia Wisconsin Wyoming

State

ZIP Code

Delivery Location Hours of Operation (delivery window): *

ex: Whitney Chamberlin, 404-754-1600

Delivery Contact Name: *

First Name

Last Name

Delivery Contact Mobile Phone Number: *

ex: (404) 754-1600

Delivery Contact Email: *

ex: whitney@yeahfieldtrip.com

Backup Delivery Contact Name: *

Back-up delivery contact name/email should be someone from Topo Chico, NOT someone from the event

First Name

Last Name

Backup Delivery Contact Phone Number: *

ex: (404) 754-1600

Backup Delivery Contact Email: *

ex: whitney@yeahfieldtrip.com

Product Direct To Event? *

Yes

No

Official Name Of Event *

Product Deliver to Storage Unit? *

Yes

No

Delivery Location Hours of Operation *

Delivery Location Type *

Business Storage Garage Residence Event Other

Other Delivery Location Type *

Call 24 hours prior to delivery *

Yes

No

Is there a loading dock at delivery location? *

Yes

No

Is a lift gate needed on truck? *

Yes

No

Is a Pallet Jack needed? *

Yes

No

Inside Delivery? (Driver hand unload) *

Yes

No

Be specific where & how the delivery needs to get to the final location: *

Shipper

Tracking Number

Status

Notes

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