Contract Bottling Questionnaire

Complete the Private Label & Bottling Questionnaire to request a quotation for bottling services.

Name: Title:

Company: Email:

Shipping Address: Billing Address:

Phone Number: Alternate Phone Number:

Fax Number: Website URL:

Tax ID Number: Years in Business:

How did you find Nicotine Giant?

About Your Products

How many unique e-juice flavors do you need bottled and labeled?

How many nicotine levels needed?

What is your expected number of bottles per month?

This product currently being manufactured by: Self Another Manufacturer New Product

If another manufacturer, what is your reason for investigating a different manufacturer? Quality Volume Service Other
If you selected Other, please explain:

At what retail price range are you looking to sell your product?

What is the target date you want your product to go to market?

Do you have samples of e-juice flavors? Yes No

Would you prefer glass or plastic dropper bottles, and what size would you like us to use? Glass Plastic Both
Bottle Size(s) Customer Provided Yes No

Will you require Label Design Services? Yes No

If label art already exists, will you be providing us with printed labels or would you like us to include label printing with your order? Yes.I will provide labels No.Please print labels

Please enter the following code into the box provided: