[Contact information
for Privacy Official]
Privacy Request Form
Distributor Application
Date
Company Name
Address |City
Province | State
Country
Postal Code | Zip Code
Phone number | Other phone number
Email address
Territories | City Covered
Number of Stores or Accounts
Some Products Carried
Number of Years in Business
Bank Reference
Bank Reference
Bank Contact
Name
Phone
Branch
Fax
Address
Email
Account Number
Credit references of creditors granting the largest amount of credit to your company
1.
Name
Phone
Address
Fax
Account Number
Email
Contact
2.
Name
Phone
Address
Fax
Account Number
Email
Contact
For Distributors
Company sales volume
for most recent year
Total # of Field Sales Force
Distribution Capability:
National: Regional: # of
States:
Total number of employees
In-house Sales Force
Current Distribution
Reps., Jobbers, etc
Email
Agents
Approximate % of Sales Volume by Leading Accounts Sold
National Chain
Drug Stores
Regional Chain
Convenience Stores
Department Stores:
National Chain
Catalog Stores
Buying Offices
Toy Stores
Discount Stores
Other
Wholesaler
Do you plan to conduct any advertising or promotion to support the product?
☐
Yes
☐
No
If yes, what type?
☐
Consumer Advertising In-Store Materials:
☐
Sales/Trade Incentives Co-op Advertising
☐
Trading Advertising Other:
☐
Does your company use an advertising agency?
1. Objective
Concise statement of what you’re trying to achieve:
Include information with reference to size of market, major competitors, respective
shares of market and current trends:
2. STRATEGY
How the product will be sold:
What advertising and promotional budget, packaging, POS materials, cooperative merchandising
agreements, etc:
Define specific distribution strategies with regards to key retailers:
3. Tailored Idea
Specific action(s) concept(s) or program(s) that will be employed to achieve objectives
and support strategies. These comments should be more representative of tactics than
strategy (e.g., sales meeting to announce/kick-off the launch of product line(s), sales
tools, advertising, handtags, packaging design, POS materials, etc.)
4. Terms of Proposal
Marketing date
Product category (define line)
Sales forecasts year 1 and year 2 (in wholesale dollars)
Advertising/promotional budget. (Be specific with regards to dollar amounts and how they are budgeted –
e.g., TV, retail, trade promotion, POS materials, etc.)
Name
Date
Name
Date
Signature
Date
For Administrative Use Only:
Date received
Action taken
Date
Action taken
Date
Privacy Official signature
Date
Attach additional documentation, if applicable.