Company Name*

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip Code*

Phone*

Fax

Email*

Web Address

Product Name*

Product Description*

Country of Origin?*

Is availability seasonal?*

Are you willing to carry a guarantee or warranty?*

Are instructions, directions, or assembly
specs provided with product?:*

Suggested Retail Price to Public?*

Are you willing to Drop Ship?*

Will you agree to holding prices for a
full calendar year?*

Do you currently have the rights to
market this product?*

If not, who does?

Are you the manufacturer?*

Where are you advertising currently?

What other companies currently carry your product?

Do you have a Minimum Advertised Pricing Policy?*

Do you have product images?*

Lead time from date of initial order?*

Is there a trademark or copyright on this product?*

If SHOPUSI.COM is interested in your product for further review, will there be a charge for samples you send? Please NOTE: Products submitted to SHOPUSI.COM will not be returned unless submitted in writing. All products returned to Vendor will be at Vendor Cost.*