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Client/Vendor/Host Information Form
* = Required Information
Please fill out this form as completely as possible.
Company Info
Company
*
Date Established
Web Address
Address
City/St/Zip
Phone
*
Fax
Email
*
# of Employees
Description of Company/Product/Service
*
Mission/Vision/Values
Tag Line
Company Sales Volume
YTD Units
YTD Sales
Retail Cost of Product
Where can your product(s) be purchased?
*
Is your company certified as a Woman Owned business?
Yes
No
Is your company certified as a Minority Owned business?
Yes
No
Structure (LLC, Sole Prop., etc.)
Company Contact
Phone
Fax
Email
About the Owner
Name
Address
City/St/Zip
Phone
Fax
Email
Professional Bio
Please provide other information that may be helpful in promoting your brand/product
Phone
Fax
Email
Social Media Information
Facebook
Twitter
Instagram
Other
Other
Authorized Signature
*
Date
*
Submit
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