First Name

Last Name

Company

Company Description

Job Title

Phone

Mobile Phone

Email

How many stores do you have? Single-Store2-56-1516-3031-5051-7071-100101+

What region do you have stores in? New England RegionMid-Atlantic RegionSouthern RegionMid-West RegionSouth-West RegionRocky MountainsPacific Coastal RegionInternational

What products are you looking to source? Center StoreCorporate ServicesFinancial ServicesFresh ProductsHealth and WellnessOperational ServicesSeasonal MerchandiseStore Design & EquipmentTechnology Solutions

What is your store format? Traditional GrocerySmall GroceryFresh FormatEveryday Low PriceHigh/LowUpscaleWarehouseNon-Traditional GrocerySpecialty

Does your company have an open to buy that you are currently sourcing for? Yes Not currently but we will in the next 12 months No

Which best describes your roll for purchasing products or service? I am the final decision maker I influence decisions that are made I am not responsible for decisions

Have you booked your room within the NGA Show room block yet through Connections Housing? Yes No

Do you have any other colleagues who would be a good fit for our MATCH program? Please include their name and contact info in the box below.

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