Order Form for Beverages

Beverage Order Form
Use this form to order Premium Beverages on line
(Order Non-Beverage Products)

Prices listed below apply to established accounts within designated minimums and areas, which include: New Hampshire, Maine (Portland and South), Massachusetts, Rhode Island and parts of Connecticut. Deposits, where applicable, will be added.

All computer orders must be received no later than 5 pm on the day prior to your regularly scheduled delivery day.

All orders, pricing and expected delivery dates will be confirmed telephonically. An order number will be provided to submit with your payment.

Company Name (required)

Contact (required)

Telephone (required)

Address

City / State / Zip

Fax

E-Mail

Number of Cases	Flavor	Price
	Old Fashioned Rootbeer	Call or Email for Pricing
	Diet Rootbeer	Call or Email for Pricing
	Birch Beer	Call or Email for Pricing
	Jamaican Style Ginger Beer	Call or Email for Pricing
	Vanilla Cream Soda	Call or Email for Pricing
	Iced Tea	Call or Email for Pricing
	Lemonade	Call or Email for Pricing
	Orange Soda	Call or Email for Pricing
	Raspberry Lime Rickey	Call or Email for Pricing
	Fruit Punch	Call or Email for Pricing
	Black Cherry	Call or Email for Pricing
	Cola	Call or Email for Pricing
	Ginger Ale	Call or Email for Pricing
	Spring Water, 1/2 Liter (Flat Cap twist-off)	Call or Email for Pricing
	Premium Sparkling Water, Natural	Call or Email for Pricing

Enter any special instructions or additional orders in the space provided below.
Click the "SEND ORDER" button to submit your order.

Private Label Specialties, Ltd. will contact you to confirm your order and pricing, and to make arrangements for payment. An order No. will be assigned at that time.

If you want your name on it, we can do it . . .


	Toll Free: 888-669-6632

	Fax: 603-641-2266