1Partner Info2Distribution Info3Sales Info4Marketing Info Vendor Name* Brand Names* Address* Street Address Address Line 2 City State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*FaxWebsite* Contact Name* First Last Title* Phone*Email* Referred By What 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 with Do you have Distributor Pricing available?* Yes No Direct 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?* Yes No Maybe Do you have a sales team?* Yes No How many?Do you have a manufacturer rep group?* Yes No Name Retailer Margin*Year 1 Sales Foecast*Year 2 Sales Forecast*Sales Dollars Transitioning*Is item ranking available?* Yes No Number of SKUs Manufactured*Shipping Origin / Location Address* Number of SKUs ASC Should Carry*Prepaid Freight Minimum*Pickup Allowance?* Yes No Pickup Allowance Amount*Swell Allowance?* Yes No Purchase Discount?* 2% 10, N 30 Other No UPCs Available?* Yes On All Packaging Yes On Some Packaging No Weight and Dimensions Available?* Yes in Excel Format Yes in Another Format No Notes Guaranteed sale on all products?* Yes No Price Lists Available* Yes in Excel Format Yes in Another Format Initial Stock Offering Available?* Yes No Ongoing Discounts Available?* Yes No Samples Available* Yes No Can you provide high resolution digital color images of products and company logo?* Yes No Willing to meet with ASC to establish an annualized promotional budget?* Yes No
