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RainStation(TM) Co-Op/Group Order Form

Non-Local, OUT OF AREA Purchase Request Orders ONLY, i.e. outside of MD, DC, Northern VA USA.

If you represent a group wishing to purchase 75+ RainStations or wish to be apart of a larger group purchase (buying co-op to pool customer orders) in your area, please use the following form below.
After submitting the form we will contact you further with more information on availability/shipping/pricing. Please fill in your contact information and the quantity of each color RainStation you would like to purchase.

Contact Information:

* - Required Fields

Company/Organization (if any):
Contact Name*:
Email Address*:
Address1*:
Address2:
City*:
State*: Requires: 2 character state code.
Zip Code*: Requires: 5 digit zip only
Phone Number*:	() -
Comments:

Desired Purchase Quantities:

RainStation in Terracotta Color, Quantity*:
RainStation in Granite Color, Quantity*:
RainStation in Moss Color, Quantity*:

Form Submission Security Check:

To prove your a real human wanting to submit this form, please enter the "two words" in the altered image below into the field below. The "reCAPTCHA" is a human image recognition security system to guard against bad/fake automated submissions.