New Vendor Inquiry – United Aqua Group

Company Name*

Company Contact*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Best time to call.*

Were you referred by?*

UAG Member Company*

Name*

First Last

Does member currently purchase direct?*

Yearly Units*

Yearly Volume in Dollars*

Employee Name*

First Last

How did you hear about UAG?*

Type of Vendor*

Please describe*

Please select all that apply:*

Please describe:*

Do you currently sell online?*

How different is your online pricing from distributor or buying group pricing?*

Do you currently sell to distributors and/or buying groups?*

What discount percentage will you offer UAG?*

To which of the following prices is the discount applied?*

Please describe*

Please select all you are willing to offer UAG members?*

Please describe*

How much total yearly volume do you anticipate will go through UAG in your first active year?*

Please describe in units or dollar amount.

Additional comments.