Your Name*

Your Email*

Your Message*

* = required field

Contact Name*

Contact Title*

Email Address*

Phone Number*

Company Name*

Company Address*

Company Website*

How will you sell Seril’s Chakka Chips? (Check all that apply)*
OnlineAt a retail storeOutside the USAOther

What type of store do you own?*

How many locations do you have?*

Which distributors do you currently work with (if any)?*

What is the estimated monthly quantity you’d like to purchase?*
0-10 cases11-24 cases25 – 50 cases50+ cases

* = required