Name *

First Name

Last Name

Phone *

(###)

###

####

Shipping Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Inserts *

Do you need an additional cap insert?

1/4oz orifice reducer

1/4oz glass dropper

1oz orifice reducer

1oz glass dropper

2oz glass dropper

4oz glass dropper

No, thank you.

Payment *

Please select how you would like to pay. (By opting to pay with a card, you are giving TGH permission to charge your card without you present.)

Send invoice via email.

Charge my debit/credit card on file. (This is a card that you have provided TGH with prior to this order.)

I will provide you with a debit/credit card.

Card information

(This card will be filed in TGH's POS system and streamlines your reordering process.)

First Name

Last Name

Billing Address

Same as shipping

Other

Billing address

Please provide your billing address if it is different than your shipping

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Receipt

How do you prefer to receive your receipt?

Text the number that I provided, please.

Email Works!

No receipt needed.