New Vendor Product Questionnaire Template
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1
2New Vendor Product Questionnaire
Please fill out this form if you are presenting a new product to Walgreens for store resale
Company Info:
Company: ______________________
Established Date: ___ / ___ / ____
Address: _______________________
Tax ID #: _____________________
City/St/Zip: _____________________
Duns & Bradstreet Listing #: _________
Telephone: ( __ ) ___ - ______
Are you a member of Uniform Product Council: Yes
No
Fax :
( __ ) ___ - ______
UPC Membership No: ____________
Sales Contact: ___________________
# of Employees: _____ # of Minority Employees: _____
Title: ___________________________
Are you a World Wide Retail Exchange member: Yes
No
Email Address: ____________________
Do you use EDI: Yes
No
If yes, please check: PO
ASN
Invoice
Payment
EDI Comments:________________________
Company Background:
Classification:
Type
Ownership
(check all that apply):
(please check):
Represented by Broker: Yes
No
Sole Proprietor: Yes
No
Male Owned %:
Manufacturer: Yes
No
Corporation:
Yes
No
Female Owned %:
Distributor: Yes
No
Partnership:
Yes
No
Service Provider: Yes
No
Owned: Publicly
Privately
Please indicate the ethnic origin of your company's ownership:
Who is your sales representative?___________________________
Is your company certified as a Woman Owned business? Yes
No
Is your company certified as a Minority Owned business? Yes
No If Yes, please specify:_________________
Caucasian/White ____
Native Hawaiian ____
Pacific Islander ____
Black/African American ____
American Indian ____
Hispanic/Latino ____
Asian ____
Native Alaskan ____
Other: Please Specify____________________________________________________
Do you certify that the next 3 statements are all true: Yes
No
* Forced labor, or illegal child labor is not, and will not be, used in the manufacturing of your products
* OSHA standards are met in your plants
* Your company is in compliance with EPA regulations
Net
Total Debt &
# of
Company Sales Volume:
$ Volume (in 1000s)
Income
Payables
Clients
Last Year 20 _____
Previous Year 20 _____
Previous Year 20 _____
Please provide the names and addresses of all factories used in the manufacturing
of your products. (attach additional paper, if necessary)
Plant/Office Site
Location:
Square Footage:
Geographic Shipping Range
Please choose one: National
Regional
Local
If regional/local, please indicate service areas by city and state: ___________________________________
What is your target division: Walgreen stores
Have you shopped at Walgreen's stores: Yes
No
Marketing/Promotional Budget:
Products:
Patent Issued:
Yes
No
This Year: __________________________________
Next Year: _________________________
Patent Applied For: Yes
No
Last Year: _________________________
Previous Year: _____________________
Previous Year: _____________________
New Product Information:
Please describe your product: ________________________________________________________________
_________________________________________________________________________________________
Where is your product made:
%USA: ____ %Offshore: ____ Last Year's Sales Units: ___________
How long has it been on the market: ____________________
Last Year's Sales Dollars: ________
Brand Name(s): _____________________________________
List all direct competitive products:______________________________________________________
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