Sqwincher® 5-Gallon Cooler Online Order Form

Purchase 5 cases of Sqwincher® 64 oz. liquid concentrate
and receive 6 complimentary Carafes!

Company Name:*

How many Carafes did you qualify for (limit 18 Carafes)?

Your Name:*

First NameLast Name

Job Title:*

Type of Business:*

Shipping Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Phone (Daytime)*

Area CodePhone Number

E-mail*

Broker Rep Name:

If Known

Distributor Name:*

Where qualified products were purchased

Qualified Products for Complimentary Carafes and the KPFG Cash Back $2.00 per case rebate.

Are you already a KPFG Cash Back program member?*

Your Company Classification?*

Upload Proof-of-Purchase

Browse Files

Upload photos, scans or other digital formats of your invoice(s). You can also upload distributor usage report documents.

If you have any issues uploading your proof-of-purchase, you can also e-mail proof-of-purchase to kentcashback@letsincent.com or call (417) 289-8880.

OFFER CODE: 19SQWCOOL (Online Order Option)