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Are you a new customer or existing customer?
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Name of the Person placing the order:
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Customer Number (if applicable)
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PO Number (if applicable)
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Cases of ORIGINAL flavor:
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Cases of SPICY flavor:
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Cases of MILD flavor:
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Pallets of ORIGINAL flavor (55 cases/pallet):
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Pallets of EXTRA SPICY flavor 55 cases/pallet:
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Pallets of MILD flavor (55 cases/pallet):
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Special instructions and/or special orders:
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