You can fill out and E-mail this form by clicking the SUBMIT button, or you can print, fill out, and FAX the form to Kevin Schlussel at 973-614-0600

Please provide us with the following information for products you would like to sell to Inter American
 
  
   Item Description

  
   Item Number (UPC Code)

  
   Manufacturer Code Date / Expiration Date

  
  Case Pack

  
   Quantity Available @ Cost per unit

  
   Cases per pallet

Special Comments (if any)

Name Title Company

Tel # Fax # Email

Postal Address


Please tell us how you would like to be contacted:  E-Mail Phone Mail Fax

    
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