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A&M – Customer Drink Selections Form

Step 1 of 12 – Customer Information

8%

Dixie Narco 501E

Please complete the following form with your desired 9 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Dixie Narco 600E

Please complete the following form with your desired 9 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Dixie Narco 276E

Please complete the following form with your desired 7 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Royal 650

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Royal 542

Please complete the following form with your desired 8 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Royal 660

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.e.

Royal 768

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Vendo 621

Please complete the following form with your desired 8 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Vendo 721

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Vendo 721 – 8 Select

Please complete the following form with your desired 8 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Vendo 720

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Vendo 576

Please complete the following form with your desired 8 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

Vendo 511

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor, Package Type, Drink Size, & Selling Price.

12oz Can Only – 5 Selections

Please complete the following form with your desired 5 drink selections. The information you will need to complete this form is as follows: Drink Flavor and Selling Price.

12oz Can Only – 6 Selections

Please complete the following form with your desired 6 drink selections. The information you will need to complete this form is as follows: Drink Flavor and Selling Price.

12oz Can Only – 7 Selections

Please complete the following form with your desired 7 drink selections. The information you will need to complete this form is as follows: Drink Flavor and Selling Price.

12oz Can Only – 8 Selections

Please complete the following form with your desired 8 drink selections. The information you will need to complete this form is as follows: Drink Flavor and Selling Price.

12oz Can Only – 9 Selections

Please complete the following form with your desired 9 drink selections. The information you will need to complete this form is as follows: Drink Flavor and Selling Price.

12oz Can Only – 10 Selections

Please complete the following form with your desired 10 drink selections. The information you will need to complete this form is as follows: Drink Flavor and Selling Price.

Customer Information

Enter your information so we can match your drink selections to your order.

Your Name(Required)

Enter the name used when making this purchase.

First Last

Company Name

Enter your company name, or leave blank if you do not have a company name.

Your Email(Required)

Enter Email Confirm Email

Your Phone Number(Required)

Machine Number

If you are purchasing more than one drink vending machine for this order, complete this form for each drink machine you are ordering. Increment the Machine Number accordingly for every new entry. Example: If you are purchasing three drink vending machines, enter ‘1’ for your first completed form and ‘2’ for your second completed form, etc., etc.

Please enter a number from 1 to 50.

501E Drink Selection 1

NOTE: Selection number 1 on this model is double the capacity than all other selections. Typically, the most popular drink is loaded into selection number 1.

Royal Drink Selection 1

NOTE: Selection numbers 1 and 2 on this model are double the capacity than all other selections. Typically, the most popular drink are loaded into selection numbers 1 and 2.

Drink Selection 1

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Royal Drink Selection 2

NOTE: Selection numbers 1 and 2 on this model are double the capacity than all other selections. Typically, the most popular drink are loaded into selection numbers 1 and 2.

Drink Selection 2

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly..

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 3

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 4

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly..

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 5

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 6

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 7

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 8

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 9

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Drink Selection 10

Drink Flavor(Required)

Package Type(Required)

Bottle

Can

Drink Size(Required)

Select the drink size. NOTE: Soft 16.9oz water bottles and other drink sizes smaller than the standard 12oz can will not vend correctly.

12oz

16oz

16.9oz

20oz

24oz

Other

Price(Required)

What price would you like to sell this drink for?

Please enter a number from 0 to 99.95.

Additional Info

Is there any additional information about your drink selections that we need to be aware of?

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Our vending consultants are happy to answer any questions or concerns you may have.
Call 770-482-7993 or Email one of our consultants at: [email protected]

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