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:
*City / State / Zip:
*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: 

*Dunn & Bradstreet Number:

*Product Categories:  

*Describe your product offering:

*Who are your primary competitors, brands, etc?

*Are your products in retail packaging complete with GTIN/UPC?
*Do your shipping cartons use SCC-14 codes?

*Where is your product currently being sold?
Retail Stores Examples: 
Internet Examples: 
Rental Examples: 
Industrial/Commercial 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
  Invoice (810) (required) 
  Purchase Order (850) (required) 
  Advance Ship Notice (856) (required) 
  Credit Approval (864) (required) 
  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):