New Vendor Product Questionnaire Template Page 2
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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
Product Safety/Regulations/Insurance:
Are there any safety issues associated with your product:
Yes
No
(If yes, please attach explanation)
Does your company have liability insurance:
Yes
No
Insurance Company: _________________________
Amount: _________________________
What is the current product capacity and the percentage of production capacity you are currently running:
_____________________________________________________________________________________
Are you a private label manufacturer: Yes
No
Will we, or our agent be allowed to inspect your factories: Yes
No
If No, please explain: ____________________________________________________________________
Please list your company's top 5 current accounts:
Name:
Address:
Volume (in Units):
1
2
3
4
5
Non-Walgreen Business References (ex: financial institutions, other retailers, etc):
Corporation Name Address
Contact
Phone
Walgreen References (ie. Category Managers):
Name
Title
Address
Phone
I certify that the information supplied on this form is true and correct.
I will advise Walgreen Co. if any information supplied should change.
Company: _____________________________
Date: __________
Certified By: ___________________________
Print Name: ____________________________
Title: __________
Thank you for your cooperation in completing this questionnaire. We appreciate your interest and
will contact you after we have reviewed your proposal packet. All information supplied to us will be
kept confidential. Please return this completed questionnaire, along with a copy of
your certificate of product liability and three non-returnable samples of your products to the address
below. Please do not submit this questionnaire separately.
Please send proposal packet to:
Walgreen Company
200 Wilmot Road MS#:
Deerfield, IL 60015
Attn: Category Manager:
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