Customer Welcome and Information Request Form
Subject
First Name
Last Name
Company Name
Company Address
Email
Phone
What's the best way to reach you?	Phone Email Text or Messenger
Company Website
Customer Business Description
Approximate Yearly Revenue	Less than $100K $100K to $500K $500K to $1M $1M to $5M $5M to $10M Greater than $10M
Company's Target Market
How did you find out about Bloomios?
How can Bloomios help you?
Custom Formulations, Research and Development
Reverse Engineering Services
Private Label Services
Your Private Label services objectives are?	I currently own a brand or brands and need a cGMP manufacturer.? I am building a new brand and need a cGMP manufacturer.?
Estimates of quantity of product per SKU?
Wholesale Services
Wholesale product formats to be sold?	Human Edibles Pet Edibles Topicals and Creams Tinctures Shots and Beverages Vape Other
Bulk Materials Procurement
Bulk materials to be procured by Bloomios?	Cannabinoids (non-psychoactive) Cannabinoids (psychoactive D8 D9 HHC Etc) Nootropics (Mushrooms Etc) Bulk edible products for coating Other
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