1 Partner Info2 Distribution Info3 Sales Info4 Marketing Info Vendor Name*Brand Names*Address* Street Address Address Line 2 City State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*FaxWebsite* Contact Name* First Last Title*Phone*Email* Referred ByWhat types of products do you provide? Check all that apply.* Feed / Ag Frozen / Refrigerated Product Home, Yard, & Kennel Pet Food Remedies, Health & Grooming Sanitation Toys Treats Wild Bird Caged Pets Other Please list all pet specialty distributors that you are currently working withDo you have Distributor Pricing available?*YesNoDirect sales retailers (please list all)Retail Distribution Channels* Independent Pet Specialty Only Specialty Stores (Petco, Petsmart, Natural Foods) Direct Grocery / Mass Regions / areas you're seeking distribution* West (California, Oregon, Washington, Nevada, Utah) Northeast (Ohio, Pennsylvania, West Viginia, Kentucky, Indiana, Michigan) Southeast (Maryland, Delaware, Virginia, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Florida) South (Texas, New Mexico, Arizona, Louisiana, Arkansas, Missouri) Central (Minnesota, Wisconsin, Iowa, Illinois, Indiana, Missouri) Approved Certifications APHIS AIB Oregon Tilth Cyclemic Res OCIA USDA AAFCO Ins. GRI Others Are you seeking an exclusive agreement?*YesNoMaybeDo you have a sales team?*YesNoHow many?Do you have a manufacturer rep group?*YesNoName Retailer Margin*Year 1 Sales Foecast*Year 2 Sales Forecast*Sales Dollars Transitioning*Is item ranking available?*YesNoNumber of SKUs Manufactured*Shipping Origin / Location Address*Number of SKUs ASC Should Carry*Prepaid Freight Minimum*Pickup Allowance?*YesNoPickup Allowance Amount*Swell Allowance?*YesNoPurchase Discount?*2% 10, N 30OtherNoUPCs Available?*Yes On All PackagingYes On Some PackagingNoWeight and Dimensions Available?*Yes in Excel FormatYes in Another FormatNoNotes Guaranteed sale on all products?*YesNoPrice Lists Available*Yes in Excel FormatYes in Another FormatInitial Stock Offering Available?*YesNoOngoing Discounts Available?*YesNoSamples Available*YesNoCan you provide high resolution digital color images of products and company logo?*YesNoWilling to meet with ASC to establish an annualized promotional budget?*YesNo
