Collection Request Form

"*" indicates required fields

Client Name*

Client PO #*

Total Pallets*

Total Boxes*

Total Liters*

Total Value*

Supplier Contact Person*

Supplier Email Contact*

Warehouse Address*

Street Address Address Line 2 ZIP / Postal Code Country

Ready Date*

Buyer PO #*

Vendor Name*

Vendor Invoice #*

SKU (Only for GLS Warehouse Clients)

Wine*

Appellation (Only for GLS Warehouse Clients)

Vintage*

Quantity (Bottles)*

Bottle Size*

Bottles per Box / Piece (Only for GLS Warehouse Clients)

Total Boxes / Pieces*

9 L Equivalent*

Total Value (Foreign) per SKU*

Total Value (USD) per SKU*

ABV*

Country & Region of Origin*

State / Province / Region Country

Color*

Still / Sparkling / Spirits*

Name

This field is for validation purposes and should be left unchanged.