{"id":3118,"date":"2018-01-22T09:17:01","date_gmt":"2018-01-22T15:17:01","guid":{"rendered":"http:\/\/www.uniquelygourmet.com\/?page_id=3118"},"modified":"2018-01-27T20:57:22","modified_gmt":"2018-01-28T02:57:22","slug":"wholesale-order-form","status":"publish","type":"page","link":"https:\/\/www.uniquelygourmet.com\/index.php\/wholesale-order-form\/","title":{"rendered":"Wholesale Order Form"},"content":{"rendered":"<p><script type=\"text\/javascript\" src='http:\/\/www.uniquelygourmet.com\/wordpress\/wp-includes\/js\/wholesale-form.js'><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/script><\/p>\n<h1 style=\"text-align: center;\">UNIQUELY GOURMET WHOLESALE ORDER FORM<\/h1>\n<hr \/>\n<h3>Customer Information:<\/h3>\n<form action=\"http:\/\/www.uniquelygourmet.com\/wordpress\/wp-includes\/wholesale-confirm.php\" method=\"POST\">\n<table width=\"100%\">\n<tbody>\n<tr>\n<td>*First Name: <input name=\"first\" required=\"required\" type=\"text\" \/><\/td>\n<td>*Last Name: <input name=\"last\" required=\"required\" type=\"text\" width=\"50%\" \/><\/td>\n<\/tr>\n<tr>\n<td>*Email Address: <input name=\"email\" required=\"required\" size=\"100\" type=\"text\" \/><\/td>\n<td>*Phone: <input name=\"phone\" required=\"required\" size=\"100\" type=\"text\" \/><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">*Company Name: <input name=\"company\" required=\"required\" size=\"100\" type=\"text\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td colspan=\"3\">*Street Address: <input name=\"street\" required=\"required\" size=\"100\" type=\"text\" \/><\/td>\n<\/tr>\n<tr>\n<td>*City: <input name=\"city\" required=\"required\" type=\"text\" \/><\/td>\n<td>*State:<select name=\"state\"><option value=\"AL\">AL<\/option><option value=\"AK\">AK<\/option><option value=\"AZ\">AZ<\/option><option value=\"AR\">AR<\/option><option value=\"CA\">CA<\/option><option value=\"CO\">CO<\/option><option value=\"CT\">CT<\/option><option value=\"DE\">DE<\/option><option value=\"FL\">FL<\/option><option value=\"GA\">GA<\/option><option value=\"HI\">HI<\/option><option value=\"ID\">ID<\/option><option value=\"IL\">IL<\/option><option value=\"IN\">IN<\/option><option value=\"IA\">IA<\/option><option value=\"KS\">KS<\/option><option value=\"KY\">KY<\/option><option value=\"LA\">LA<\/option><option value=\"ME\">ME<\/option><option value=\"MD\">MD<\/option><option value=\"MA\">MA<\/option><option value=\"MI\">MI<\/option><option value=\"MN\">MN<\/option><option value=\"MS\">MS<\/option><option value=\"MO\">MO<\/option><option value=\"MT\">MT<\/option><option value=\"NE\">NE<\/option><option value=\"NV\">NV<\/option><option value=\"NH\">NH<\/option><option value=\"NJ\">NJ<\/option><option value=\"NM\">NM<\/option><option value=\"NY\">NY<\/option><option value=\"NC\">NC<\/option><option value=\"ND\">ND<\/option><option value=\"OH\">OH<\/option><option value=\"OK\">OK<\/option><option value=\"OR\">OR<\/option><option value=\"PA\">PA<\/option><option value=\"RI\">RI<\/option><option value=\"SC\">SC<\/option><option value=\"SD\">SD<\/option><option value=\"TN\">TN<\/option><option value=\"TX\">TX<\/option><option value=\"UT\">UT<\/option><option value=\"VT\">VT<\/option><option value=\"VA\">VA<\/option><option value=\"WA\">WA<\/option><option value=\"WV\">WV<\/option><option value=\"WI\">WI<\/option><option value=\"WY\">WY<\/option><\/select><\/td>\n<td>*Zip: <input name=\"zip\" required=\"required\" type=\"text\" \/><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\">Notes: <input name=\"notes\" size=\"2000\" type=\"text\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<hr \/>\n<h3>Order Information:<\/h3>\n<table id=\"dataTable\" border=\"1\" width=\"100%\">\n<tbody>\n<tr>\n<td>Select to Delete<\/td>\n<td>Product<\/td>\n<td>QTY<\/td>\n<td>Sample Case Jars<\/td>\n<\/tr>\n<tr>\n<td><input name=\"chk[]\" type=\"checkbox\" \/><\/td>\n<td><select name=\"PRODUCTS[]\" required=\"required\"><option value=\"-----\">&#8212;&#8211;<\/option><option value=\"10005-Farm House Pickles 32 oz.\">10005-Farm House Pickles 32 oz.<\/option><option value=\"10010-Habanero Chunk Pickles 32 oz.\">10010-Habanero Chunk Pickles 32 oz.<\/option><option value=\"10015-Dilled Pickles 32 oz.\">10015-Dilled Pickles 32 oz.<\/option><option value=\"10352-Candied Jalapenos 32 oz.\">10352-Candied Jalapenos 32 oz.<\/option><option value=\"10122-Peachy Peach Halves 32 oz.\">10122-Peachy Peach Halves 32 oz.<\/option><option value=\"10110-Mild Pickled Eggs 32 oz.\">10110-Mild Pickled Eggs 32 oz.<\/option><option value=\"10112-Spicy Pickled Eggs 32 oz.\">10112-Spicy Pickled Eggs 32 oz.<\/option><option value=\"10030-Sliced Green Tomatoes 32 oz.\">10030-Sliced Green Tomatoes 32 oz.<\/option><option value=\"10040-Bread N' Butter Pickles 32 oz.\">10040-Bread N&#8217; Butter Pickles 32 oz.<\/option><option value=\"10025-Big As Texas Pickle 24 oz.\">10025-Big As Texas Pickle 24 oz.<\/option><option value=\"10050-Granny's Hot Sweet Pickles 24 oz.\">10050-Granny&#8217;s Hot Sweet Pickles 24 oz.<\/option><option value=\"10060-What'cha Dill Pickles 24 oz.\">10060-What&#8217;cha Dill Pickles 24 oz.<\/option><option value=\"10075-Papa Dill Pickles 24 oz.\">10075-Papa Dill Pickles 24 oz.<\/option><option value=\"10100-Hoot N' Holler Spicy Pickles 24 oz.\">10100-Hoot N&#8217; Holler Spicy Pickles 24 oz.<\/option><option value=\"10120-Peachy Peach Halves 24 oz.\">10120-Peachy Peach Halves 24 oz.<\/option><option value=\"10125-Asparagus Spears 16 oz.\">10125-Asparagus Spears 16 oz.<\/option><option value=\"10135-Pickled Carrots Sticks 16 oz.\">10135-Pickled Carrots Sticks 16 oz.<\/option><option value=\"10150-Jalapeno Stuffed Olives 16 oz.\">10150-Jalapeno Stuffed Olives 16 oz.<\/option><option value=\"10175-Habanero Stuffed Olives 16 oz.\">10175-Habanero Stuffed Olives 16 oz.<\/option><option value=\"10200-Garlic Stuffed Olives 16 oz.\">10200-Garlic Stuffed Olives 16 oz.<\/option><option value=\"10210-Bleu Cheese Stuffed Olives 16 oz.\">10210-Bleu Cheese Stuffed Olives 16 oz.<\/option><option value=\"10215-Bread N' Butter Pickles 16 oz.\">10215-Bread N&#8217; Butter Pickles 16 oz.<\/option><option value=\"10225-Bread N' Butter Slims 16 oz.\">10225-Bread N&#8217; Butter Slims 16 oz.<\/option><option value=\"10250-Dill Pickle Slims 16 oz.\">10250-Dill Pickle Slims 16 oz.<\/option><option value=\"10275-Sweet Habanero Slims 16 oz.\">10275-Sweet Habanero Slims 16 oz.<\/option><option value=\"10300-Habanero Ghost Slims 16 oz.\">10300-Habanero Ghost Slims 16 oz.<\/option><option value=\"10302-Spicy Garlic Dill Pickle 16 oz.\">10302-Spicy Garlic Dill Pickle 16 oz.&#8221;&gt;<\/option><option value=\"10305-Sweet Fire 16 oz.\">10305-Sweet Fire 16 oz.<\/option><option value=\"10320-Sweet Pickles Chips 16 oz.\">10320-Sweet Pickles Chips 16 oz.<\/option><option value=\"10335-Spicy Garlic Pickle Chips 16 oz.\">10335-Spicy Garlic Pickle Chips 16 oz.<\/option><option value=\"10350-Candied Jalapenos 16 oz.\">10350-Candied Jalapenos 16 oz.<\/option><option value=\"10360-Spicy Pickled Quail Eggs 16 oz.\">10360-Spicy Pickled Quail Eggs 16 oz.<\/option><option value=\"10365-Mild Pickled Quail Eggs 16 oz.\">10365-Mild Pickled Quail Eggs 16 oz.<\/option><option value=\"10375-Jalapeno Quail Eggs 16 oz.\">10375-Jalapeno Quail Eggs 16 oz.<\/option><option value=\"10380-Zesty Pickled Garlic 16 oz.\">10380-Zesty Pickled Garlic 16 oz.<\/option><option value=\"10383-Savory Italian Garlic 16 oz.\">10383-Savory Italian Garlic 16 oz.<\/option><option value=\"10386-Spicy Asian Garlic 16 oz.\">10386-Spicy Asian Garlic 16 oz.<\/option><option value=\"10385-Spicy Pickled Garlic 16 oz.\">10385-Spicy Pickled Garlic 16 oz.<\/option><option value=\"10389-Habanero Garlic 16 oz.\">10389-Habanero Garlic 16 oz.<\/option><option value=\"10400-Spicy Pickled Green Beans 16 oz.\">10400-Spicy Pickled Green Beans 16 oz.<\/option><option value=\"10410-Marinated Mushrooms 16 oz.\">10410-Marinated Mushrooms 16 oz.<\/option><option value=\"10425-Pickled Okra 16 oz.\">10425-Pickled Okra 16 oz.<\/option><option value=\"10445-Pickled Beets 16 oz.\">10445-Pickled Beets 16 oz.<\/option><option value=\"10450-Fresh Ginger Beets 16 oz.\">10450-Fresh Ginger Beets 16 oz.<\/option><option value=\"10475-Hatch Baby Corn 16 oz.\">10475-Hatch Baby Corn 16 oz.<\/option><option value=\"10500-Sweet Baby Corn 16 oz.\">10500-Sweet Baby Corn 16 oz.<\/option><option value=\"20025-Bacon Bavarian Sauerkraut 16 oz.\">20025-Bacon Bavarian Sauerkraut 16 oz.<\/option><option value=\"20030-German Sauerkraut 16 oz.\">20030-German Sauerkraut 16 oz.<\/option><option value=\"20050-Chow Chow 16 oz.\">20050-Chow Chow 16 oz.<\/option><option value=\"20055-Hot Chow Chow 16 oz.\">20055-Hot Chow Chow 16 oz.<\/option><option value=\"20075-Corn and Red Bell Relish 16 oz.\">20075-Corn and Red Bell Relish 16 oz.<\/option><option value=\"20085-Sweet Hot Jalapeno Relish 16 oz.\">20085-Sweet Hot Jalapeno Relish 16 oz.<\/option><option value=\"20100-Green Tomato Relish 16 oz.\">20100-Green Tomato Relish 16 oz.<\/option><option value=\"20125-Blackeyed Pea Relish 16 oz.\">20125-Blackeyed Pea Relish 16 oz.<\/option><option value=\"30020-Five Amigos Fire Roasted Salsa (Hot) 16 oz.\">30020-Five Amigos Fire Roasted Salsa (Hot) 16 oz.<\/option><option value=\"30025-Six Shooter Fire Roasted Salsa (Hot) 16 oz.\">30025-Six Shooter Fire Roasted Salsa (Hot) 16 oz.<\/option><option value=\"30030-Habanero Salsa (Hot) 16 oz.\">30030-Habanero Salsa (Hot) 16 oz.<\/option><option value=\"30035-Salsa Grande (Hot) 16 oz.\">30035-Salsa Grande (Hot) 16 oz.<\/option><option value=\"30050-Bold Chip Salsa (Medium) 16 oz.\">30050-Bold Chip Salsa (Medium) 16 oz.<\/option><option value=\"30065-Chili Relleno Salsa (Medium) 16 oz.\">30065-Chili Relleno Salsa (Medium) 16 oz.<\/option><option value=\"30075-Chimi Changa Salsa (Medium-Mild) 16 oz.\">30075-Chimi Changa Salsa (Medium-Mild) 16 oz.<\/option><option value=\"30100-Hatch Green Corn Tamale Salsa (Medium-Mild) 16 oz.\">30100-Hatch Green Corn Tamale Salsa (Medium-Mild) 16 oz.<\/option><option value=\"30110-Black Bean and Corn Salsa (Medium-Mild) 16 oz.\">30110-Black Bean and Corn Salsa (Medium-Mild) 16 oz.<\/option><option value=\"30125-Ghost Chili Salsa (Extremely Hot) 16 oz.\">30125-Ghost Chili Salsa (Extremely Hot) 16 oz.<\/option><option value=\"30135-Mango Lime Salsa (Medium) 16 oz.\">30135-Mango Lime Salsa (Medium) 16 oz.<\/option><option value=\"30150-Peach Salsa (Medium) 16 oz.\">30150-Peach Salsa (Medium) 16 oz.<\/option><option value=\"30170-Pepper Patch Salsa (Mild) 16 oz.\">30170-Pepper Patch Salsa (Mild) 16 oz.<\/option><option value=\"30175-Salsa de Manzanilla (Mild) 16 oz.\">30175-Salsa de Manzanilla (Mild) 16 oz.<\/option><option value=\"30200-Tomatillo Avocado Salsa (Hot) 16 oz.\">30200-Tomatillo Avocado Salsa (Hot) 16 oz.<\/option><option value=\"30225-Tomatillo Salsa (Medium) 16 oz.\">30225-Tomatillo Salsa (Medium) 16 oz.<\/option><option value=\"40025-Bacon Bourbon BBQ Sauce 16 oz.\">40025-Bacon Bourbon BBQ Sauce 16 oz.<\/option><option value=\"40050-Sizzling Steak Sauce 10 oz.\">40050-Sizzling Steak Sauce 10 oz.<\/option><option value=\"40075-Premium Pepper Sauce 10 oz.\">40075-Premium Pepper Sauce 10 oz.<\/option><option value=\"40085-Classic Gourmet Marinade 16 oz.\">40085-Classic Gourmet Marinade 16 oz.<\/option><option value=\"40100-Loco Cheese Dip 16 oz.\">40100-Loco Cheese Dip 16 oz.<\/option><option value=\"40125-Queso Extreme 16 oz.\">40125-Queso Extreme 16 oz.<\/option><option value=\"40150-Queso Blanco 16 oz.\">40150-Queso Blanco 16 oz.<\/option><option value=\"40160-Blackeyed Pea Dip 16 oz.\">40160-Blackeyed Pea Dip 16 oz.<\/option><option value=\"40175-Jalapeno Honey Mustard 16 oz.\">40175-Jalapeno Honey Mustard 16 oz.<\/option><option value=\"40200-Honey Habanero BBQ Sauce 16 oz.\">40200-Honey Habanero BBQ Sauce 16 oz.<\/option><option value=\"40225-BBQ Sauce 16 oz.\">40225-BBQ Sauce 16 oz.<\/option><option value=\"40250-Salted Vodka Rib Glaze 16 oz.\">40250-Salted Vodka Rib Glaze 16 oz.<\/option><option value=\"40275-Portabello Pasta Sauce 16 oz.\">40275-Portabello Pasta Sauce 16 oz.<\/option><option value=\"40300-Roasted Garlic Pasta Sauce 16 oz.\">40300-Roasted Garlic Pasta Sauce 16 oz.<\/option><option value=\"50025-Strawberry Preserves 16 oz.\">50025-Strawberry Preserves 16 oz.<\/option><option value=\"50050-Peach Preserves 16 oz.\">50050-Peach Preserves 16 oz.<\/option><option value=\"50075-Blackberry Preserves 16 oz.\">50075-Blackberry Preserves 16 oz.<\/option><option value=\"50100-Cherry Preserves 16 oz.\">50100-Cherry Preserves 16 oz.<\/option><option value=\"50125-Raspberry Preserves 16 oz.\">50125-Raspberry Preserves 16 oz.<\/option><option value=\"50150-Blueberry Preserves 16 oz.\">50150-Blueberry Preserves 16 oz.<\/option><option value=\"50175-Apple Preserves 16 oz.\">50175-Apple Preserves 16 oz.<\/option><option value=\"50200-Apricot Preserves 16 oz.\">50200-Apricot Preserves 16 oz.<\/option><option value=\"50250-Strawberry Rhubarb Preserves 16 oz.\">50250-Strawberry Rhubarb Preserves 16 oz.<\/option><option value=\"50265-Strawberry Fig Preserves 16 oz.\">50265-Strawberry Fig Preserves 16 oz.<\/option><option value=\"50275-Whole Fig Preserves 16 oz.\">50275-Whole Fig Preserves 16 oz.<\/option><option value=\"50285-Fig Preserves 16 oz.\">50285-Fig Preserves 16 oz.<\/option><option value=\"50295-Red Tomato Preserves 16 oz.\">50295-Red Tomato Preserves 16 oz.<\/option><option value=\"55025-Strawberry Jalapeno Preserves 16 oz.\">55025-Strawberry Jalapeno Preserves 16 oz.<\/option><option value=\"55050-Peach Jalapeno Preserves 16 oz.\">55050-Peach Jalapeno Preserves 16 oz.<\/option><option value=\"55075-Blueberry Jalapeno Preserves 16 oz.\">55050-Peach Jalapeno Preserves 16 oz.<\/option><option value=\"55100-Green Pepper Jelly 16 oz.\">55100-Green Pepper Jelly 16 oz.<\/option><option value=\"55125-Red Pepper Jelly 16 oz.\">55125-Red Pepper Jelly 16 oz.<\/option><option value=\"60025-Strawberry Preserves Juice Sweetened 16 oz.\">60025-Strawberry Preserves Juice Sweetened 16 oz.<\/option><option value=\"60050-Peach Preserves Juice Sweetened 16 oz.\">60050-Peach Preserves Juice Sweetened 16 oz.<\/option><option value=\"60075-Blackberry Preserves Juice Sweetened 16 oz.\">60075-Blackberry Preserves Juice Sweetened 16 oz.<\/option><option value=\"60100-Cherry Preserves Juice Sweetened 16 oz.\">60100-Cherry Preserves Juice Sweetened 16 oz.<\/option><option value=\"60125-Blueberry Preserves Juice Sweetened 16 oz.\">60125-Blueberry Preserves Juice Sweetened 16 oz.<\/option><option value=\"60135-Fig Preserves Juice Sweetened 16 oz.\">60135-Fig Preserves Juice Sweetened 16 oz.<\/option><option value=\"70025-Apple Butter 16 oz.\">70025-Apple Butter 16 oz.<\/option><option value=\"70050-Apple Butter Juice Sweetened 16 oz.\">70050-Apple Butter Juice Sweetened 16 oz.<\/option><option value=\"70075-Cherry Butter 16 oz.\">70075-Cherry Butter 16 oz.<\/option><option value=\"70100-Peach Butter 16 oz.\">70100-Peach Butter 16 oz.<\/option><option value=\"70115-Sweet Potato Butter 16 oz.\">70115-Sweet Potato Butter 16 oz.<\/option><option value=\"70130-Pumpkin Butter 16 oz.\">70130-Pumpkin Butter 16 oz.<\/option><option value=\"80025-Pecan Syrup 16 oz.\">80025-Pecan Syrup 16 oz.<\/option><option value=\"80050-Blueberry Syrup 16 oz.\">80050-Blueberry Syrup 16 oz.<\/option><option value=\"80075-Peach Syrup 16 oz.\">80075-Peach Syrup 16 oz.<\/option><option value=\"80100-Apple Pie Syrup 16 oz.\">80100-Apple Pie Syrup 16 oz.<\/option><option value=\"80125-Strawberry Syrup 16 oz.\">80125-Strawberry Syrup 16 oz.<\/option><option value=\"80150-Blackberry Syrup 16 oz.\">80150-Blackberry Syrup 16 oz.<\/option><\/select><\/td>\n<td><input name=\"QTY[]\" required=\"required\" type=\"text\" \/><\/td>\n<td><select name=\"sample[]\" required=\"required\"><option value=\"No\">No<\/option><option value=\"Yes\">Yes<\/option><\/select><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><input type=\"button\" value=\"Add Product\" onClick=\"addRow('dataTable')\" \/> <input type=\"button\" value=\"Remove Product\" onClick=\"deleteRow('dataTable')\"  \/><br \/>\n(To delete a product first click the check box to the left of the product.)<br \/>\n<input class=\"submit\" type=\"submit\" value=\"Submit Order\" \/><\/p>\n<\/form>\n","protected":false},"excerpt":{"rendered":"<p>UNIQUELY GOURMET WHOLESALE ORDER FORM Customer Information: *First Name: *Last Name: *Email Address: *Phone: *Company Name: *Street Address: *City: *State:ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY *Zip: Notes: Order Information: Select to Delete Product QTY Sample Case Jars &#8212;&#8211;10005-Farm House Pickles 32 oz.10010-Habanero Chunk Pickles 32 oz.10015-Dilled Pickles 32 oz.10352-Candied Jalapenos 32 oz.10122-Peachy Peach Halves 32 oz.10110-Mild Pickled Eggs 32 oz.10112-Spicy [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3118","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/pages\/3118","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/comments?post=3118"}],"version-history":[{"count":52,"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/pages\/3118\/revisions"}],"predecessor-version":[{"id":4015,"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/pages\/3118\/revisions\/4015"}],"wp:attachment":[{"href":"https:\/\/www.uniquelygourmet.com\/index.php\/wp-json\/wp\/v2\/media?parent=3118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}