A&M – Customer Drink Selections Form Step 1 of 12 – Customer Information 8% Dixie Narco 501EPlease 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 600EPlease 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 276EPlease 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 650Please 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 542Please 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 660Please 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 768Please 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 621Please 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 721Please 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 SelectPlease 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 720Please 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 576Please 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 511Please 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 SelectionsPlease 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 SelectionsPlease 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 SelectionsPlease 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 SelectionsPlease 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 SelectionsPlease 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 SelectionsPlease 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 InformationEnter 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 NameEnter 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 NumberIf 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 1NOTE: 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 1NOTE: 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 1Drink 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 2NOTE: 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 2Drink 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 3Drink 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 4Drink 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 5Drink 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 6Drink 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 7Drink 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 8Drink 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 9Drink 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 10Drink 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 InfoIs there any additional information about your drink selections that we need to be aware of?CAPTCHA