Delivery Order Form
Due to current restrictions, we are limiting hand sanitizer orders to 64oz - 1 gallon orders. Bulk purchasing is not currently available for this item. Prices on products and new bottles are subject to change at any time due to supply and demand from our suppliers during the Covid-19 pandemic.

NOTE: Deliveries are within the San Gabriel Valley and surrounding area. Please message us if you are outside this area

----------------------------------------------->>>>>> INSTRUCTIONS: <<<<<<-----------------------------------------------
1. Please fill out all items on this form and be as descriptive as possible when listing products as we have many different kinds of scents/products/brands. Please include product brand, type (scent or unscented, daily, color extend, etc), amount (1/2 bottle, full, ounces).
2. After order form has been submitted you will receive a confirmation and a date your delivery can be expected via email or text.
3. If you will be providing your own bottles please leave them by the front door on delivery date.
4. Please make sure your containers are CLEAN AND DRY.
5. Please label your bottles with product name & amount.
6. You will receive a message when the Refill van is on its way to you.
7. We will then pick up bottles provided, refill, send total, wipe your bottles with disinfectant wipes and drop off ONCE YOU HAVE PAID.
8. If purchasing our bottles you will receive the total once filled. Once paid we will deliver to your front door.

We are currently accepting payments via online so as to avoid physical contact. We have Venmo, Apple pay and Zelle available.

You can find our products here: https://www.refillevolution.com/products
Email address *
First and Last Name *
Address, City Zip code and any Special Delivery Instructions (gate code, front or back porch etc) *
Texting Number (we will text you when we are close) *
Are you reusing your own bottles or purchasing new ones? *
Required
IF you need New bottles, Please be SPECIFIC WHICH bottles you want and HOW MANY you need.
I understand that if I'm using my own bottles they need to be CLEAN AND DRY in order to be filled. If they are not then they may NOT be filled. (Exception is lotion bottles since they are difficult to wash). *
I understand that if I am purchasing new bottles, the price is subject to change without notice as manufacturing prices can change at any time. *
How are you paying? *
Please select all that apply
Do you own a business and would like to set up a monthly subscription or bulk discount account? *
Please select all that apply
Please list exactly WHICH PRODUCTS and HOW MUCH you would like. If using your own bottles and you don't know how much, then estimate as best as you can. If you are both purchasing new ones and using your own, then list which products are in the NEW bottles and which are in your OWN. PLEASE BE VERY SPECIFIC. You may find our prices here (you must sign in order to see it): https://www.refillevolution.com/price-list *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy