Home Prepaid Water Cooler Order Form Prepaid Water Cooler Order Form First Name *Last Name *Phone *ExtensionLet us know your telephone extension is you have oneEmail Address *Street Address *Apartment, suite, etcGlacier Cook & Cold Water Cooler ($357.89 each)WhiteBlackThese are our most popular water coolers, they have a cold water tap and a room temperature water tap. They are available in black or white. Glacier coolers come with 5 years of warranty and are repairable by our techs.QuantitySubtotal$Glacier Hot & Cold Water Cooler ($405.62 each)WhiteBlackThis cooler has a cold water tap and hot water tap with a built in childproof handle for your safety. They are available in black or white. Glacier coolers come with 5 years of warranty and are repairable by our techs.QuantitySubtotal$Avalanche Counter Top Cooler ($335.09 each)Stock onlyStock onlyThis cooler is small enough to sit on your counter, it has one cold water tap.QuantitySubtotal$Additional DetailsIf your using a Purchase Order, this is a great place to put your PO numberGrand Total$This is how much you pay upon deliveryCredit / Debit Card * Submit Order
