*Your Name :

*Organization/Company Name :

*Street Address :

*City :

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*Zip/Postal Code :

*Country :

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Filling machines You
or your vendor
have - model & Make

M/C's in House 
(In no.)

M/C's at 
Your Vendor

(*Regular or/and Seasonal )
 Regular Capsule Consumption

Size

Millions per Month

Most common Colors

"0"

"2"

"3"

"4"

Seasonal Consumption

Size

Millions

Colors

'0'

'2'

'3'

'4'

* Free samples required of :

Size*

Cap Color*

Body Color *

 '0'

 '2'

 '3'

 '4'