First Name

Last Name

Company

Job Title

Phone

Mobile Phone (This Is Not Published And Just For Administrative Purposes)

Email

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

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

Brief description of your company:

I am interested in sourcing the following products/services: Native American MerchandiseAmericanaApparel/ClothingBeach MerchandiseBooks/Publications/Periodicals/Media (includes CDs & DVDs)Candy/Fudge/ConfectionsChildren's/Baby ItemsCustom Design/Private LabelDecorative AccessoriesDesign, Decor, FurnishingsEnvironmentally Friendly/Natural/Recycled ProductsFashion AccessoriesFootwear & AccessoriesGames/Puzzles/ToysGift Wrap & AccessoriesGourmet: Food, Beverages & WineHandmade/CraftHoliday/SeasonalHome FurnishingsJewelryLicensed ProductsMade in USANautical GiftsOutdoor Living/GardenPersonal CarePlushRetail Services & SuppliesSouvenirs/Novelty/TrendStationerySwimwear

Any colleagues who would be a good fit for our MATCH program? Yes No

Colleagues name and contact information:

What is your annual sales volume? Under $500,000 $500,000-$750,000 $750,000 - $1 Million $1Million - $10 Million $10Million - $25 Million Over $25 Million

Number of locations? No Store Front 1 Location 2 - 5 Locations 6 - 10 Locations 11 - 25 Locations More than 25 Locations

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