Distributors

Title Dr. Mr. Mrs. Ms.    Name

Title

Company

Length of time in business years months

Dun's number or Federal Tax ID

Address

Address

City Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory

  Zip Code   -         Country

Phone   -   Ext.         

Do you accept orders at this number? Yes No

Fax   -  

Best time to follow up

E-mail   (e.g. yummy@bogdonschocolates.com)

Your website address

Would you like to receive our special email offers?   

Yes No

How did you hear about Bogdon's?

Number of Sales Personnel:

   your employees   outside representatives

Do you have a showroom your customers can buy from? Yes No

Do you have your own buying shows during the year? Yes No

Do you allow vendors to have a display booth at your show? Yes No

Do you publish your own catalog? Yes No

What is your minimum order?

What are your freight terms?

What geographic areas will you ship to?

What is your percentage of customers by type?

Hotels/Restaurants    

Specialty Food Stores     

Supermarkets

Department Stores    

Convenience Stores

Other (list type and percentage) :

Please list brands you currently represent:

If you have any further comments or questions, please note them here:

Thank you for your interest in Bogdon's Chocolates.

We appreciate your time and your business.

We will contact you with pricing information upon processing of this form.

I'm done.        I would like to start over.

If you would rather print this and fax it to us, our fax number is 1-913-262-6885.