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Email address *
Retailer Name *
Retailer Account Number *
This is the 5-digit code you will find on invoices (Example Below)
City *
Your Name *
Contact Phone Number *
Sales Rep Name
As a retailer of Carroll Distributing products, I understand that most of the products have a shelf life.  If I order product that doesn’t sell through prior to the expiration date, it will not be sold to my customers and must be destroyed.  This product is my responsibility as the ordering retailer and will be destroyed at my expense. *
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