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Customer Intake Form

Thanks for your interest in working with White Bottle! To make sure we’d be a good fit for your needs, please fill out the form below, and someone will reach out to you. All your information is kept confidential.

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Company Information

Business Address
Billing Address (if Different)

Contact Person's Name


Product Specifications

I agree to a non-refundable R&D fee of $5000 is required, which will be credited towards the first order placed.
Click or drag a file to this area to upload.
I agree with a 12-week production timeline
I acknowledge and agree to the terms and conditions outlined in the New Customer Checklist. I understand that the $5000 R&D fee will be credited towards the first order.