SUPPLIER INFORMATION

Name of Company or Business*

Length of time in business*

Select duration Startup Less than one year 1 to 3 years 3 to 5 years 5 to 10 years 10 or more years

PRODUCT  INFORMATION

Brief description of merchandise*

How many items do you have for sale?*

Do products have attributes (size, color, etc.)*

No     Yes

How quickly can merchandise be shipped*

Shipping turn-around-time Sameday if received by 11:00am 24 hours after receiving order 48 hours after receiving order 72 hours after receiving order 4 to 7 days after receiving order 7 to 10 days after receiving order 2 to 3 weeks after receiving order 4 to 8 weeks after receiving order

Method of Shipping Used*

Select shipping method used US Postal Service Priority Mail Federal Express (FEDEX) United Parcel Service (UPS) Mail Boxes Etc PAK MAIL Other

EMAIL  & WEBSITE  ADDRESS

Email Address *

Site Name if available

URL of Site

MAILING ADDRESS

Address 1 *

Address 2

City *

State *

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Postal Code *

PRIMARY CONTACT

First Name *

Last Name *

FAX

Phone *

JUST A FEW MORE QUESTIONS

Comments or questions

How did you learn about the PersonalBuy Supplier Program

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