Retailer Product Information Request Form

Thank you for your interest in our Water Pillows® Portable Humidifiers to sell in your retail store.  Please fill out the form below and we will send you additional pricing information and samples for our retail store display packs, refill packs and bulk quantity offerings.  If you have any questions about the form or our products, please call Kevin Dyer toll free (877) 374-3456.

RED denotes a required field

Store Name:
Contact Name:
Telephone Number:
Address 2:
Fax Number:
Email Address:
Additional Comments:
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