• EMAIL ADDRESS OF PERSON SUMBITTING FORM. REQUIRED - IF PROVIDED BY A STORE, PLEASE USE YOUR STORE EMAIL ADDRESS
  • LEGAL CLASSIFICATION OF ITEM.
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION
  • SELECT THE MOST APPROPRIATE OPTION. IF THE PRODUCT IS MADE IN INDIANA, PLEASE SELECT INDIANA HERE.
  • SELECT THE MOST APPROPRIATE 'SELLING SIZE' OPTION. IF SOLD BY 'PACK' PLEASE SELECT APPROPRIATE PACK SIZE. IF SOLD BY SINGLE SELECT AN ML/OZ SIZE.
  • Product Info

  • PRODUCT NAME ON ACTUAL SELLING UNIT - I.E. BUD LIGHT LIME 6 PACK, ABSOLUT HANGOUT VARIETY 12 PACK, MARLBORO SPECIAL SELECT BOX, ETC. THE PRODUCT'S SHELF LABEL NAME WILL BE DETERMINED BY THIS. PLEASE BE SPECIFIC.
  • FOR EXAMPLE IS THE SELLING UNIT A GLASS BOTTLE, PLASTIC BOTTLE, CAN, TETRA, BOX, ETC.
  • HOW MANY SELLING UNITS COME IN AN UNBROKEN CASE FROM THE SUPPLIER? I.E. FOR MOST 6 PACK BOTTLED BEER THIS IS 4. FOR MOST 4 PACK CANNED BEER THIS IS 6. MOST 750 SPIRITS IS 12. ETC.
  • COMPANY NAME ON INVOICE PROVIDED BY THE SUPPLIER. I.E. SOUTHERN, NATIONAL, BEST BEER, ETC.
  • THIS FIELD IS TYPICALLY FOR USE BY THE SUPPLIER. WHICH "BOOK" IS THIS FROM? I.E. D&E, SIGNATURE, FOX, ETC.
  • SUPPLIER SPECIFIC NUMBER, FOUND ON INVOICE PROVIDED BY SUPPLIER.
  • LISTED COST OF CASE ON SUPPLIER INVOICE.
  • THIS IS THE BARCODE NUMBER SCANNED AT THE REGISTER. TYPICALLY A 12 DIGIT NUMBER FOUND ON THE SELLING UNIT ITSELF. PLEASE DO NOT USE DASHES, SPACES, OR ANY OTHER NON NUMERICAL CHARACTERS. (CORRECT: 012222688692 INCORRECT: 0-12222-68869-2)
  • TASTE PROFILE INFORMATION FOR USE WITH SIGNAGE. NOT REQUIRED.
  • Drop files here or
    Accepted file types: jpg, jpeg, png, webp, Max. file size: 4 MB.
      IF POSSIBLE, PLEASE PROVIDE A PICTURE OF BOTH THE FRONT AND BACK OF THE PRODUCT. NOT REQUIRED.