Company Name Address Telephone Fax E-Mail Address Web Site Address
Description of Properties for which you seek a license Estimated wholesale selling price per unit Estimated retail price per unit
YesNo
YesNo Trade or brand names of products sold by your company
1. 2. 3.
President: Vice President(s): Sales Director: Marketing/Advertising Director:
Name: Branch: Account #: Address: Bank Contact:
1. 2.
YesNo If not, who will manufacture this product? Where will this product be manufactured? Number of factories involved in the manufacture of this product?
Company sale volume for most recent year Company sale volume for previous year
National Regional (#of States)
1. Own sales force? # of salesmen
2. Reps., Jobbers, etc.? #
3. Agents: #
4. Total # of field sales force
Current Distribution
National Regional Chains Department Stores Buying Offices Discount Stores Drug Stores Food Stores Convenience Stores Catalog Stores Toy Stores Other (specify)
Year 1 $ Year 2 $
1. 2. 3. 4. 5. 6.
If you currently manufacture a similar type of item, what was its wholesale dollar volume for most recent year?
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