Prospective Vendor Questionnaire

Contact Us Please complete the form below and click on Submit at the bottom.   NOTE: The red asterisks * are required fields.

*Company Name: *Address: *City / State / Zip: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 West Virginia Wisconsin Wyoming *Web Address:   http://

*Contact First Name:    *Contact Last Name:

*Contact E-mail Address:

*Contact Phone Number (please provide at least one below)

Day:   Evening:   Cell:   Best Time to Call:  Any Morning Noon Afternoon *Dunn & Bradstreet Number: *Product Categories:    Pet Supplies  Tools  Paint & Sundries  Plumbing  Houseware  Lawn & Garden  Builders Hardware  Electrical  Automotive  Seasonal *Describe your product offering: *Who are your primary competitors, brands, etc? *Are your products in retail packaging complete with GTIN/UPC? YesNo *Do your shipping cartons use SCC-14 codes? YesNo *Where is your product currently being sold? Retail Stores YesNo Examples:  Internet YesNo Examples:  Rental YesNo Examples:  Industrial/Commercial YesNo Examples:  *What is your product's country of origin?    *Jensen requires the use of EDI (electronic data interchange) for processing of all purchase orders, invoices, credit memos, and advance shipment notices. Please indicate all transactions you support   YesNo Invoice (810) (required)    YesNo Purchase Order (850) (required)    YesNo Advance Ship Notice (856) (required)    YesNo Credit Approval (864) (required)    YesNo Remittance Advice (820) (required)  *Describe any national, regional or local advertising programs you may provide  (Only 250 characters will be accepted): *Describe any sales efforts you may provide to gain retail placement of your product(s) (Only 250 characters will be accepted):