Please fill out the following form if you are interested in being represented
by Presence Marketing/Dynamic Presence.

Fields marked with a * are required


Vendor Name: *
Referred By:
Item(s) Description: *

Contact Information:

Contact Name: *
Title: *
Phone: *
Email Address: *
Website:

Broker Questions:

Please select your Region(s) of Interest: *           Annual Sales: *
Midwest    
Southwest    
Rocky Mountains    
East    
Pacific Northwest    
California    
Do you have a current broker in a
Region(s) of interest? * 		Yes
No
If Yes, who is/are your current
broker(s) in this Region?
Do you have a current broker(s)
elsewhere Nationally? * 		Yes
No
If Yes, who is/are your current
broker(s) Nationally?

Distribution Questions:

Retail Distribution -
Approved and Placed (Example:
Whole Foods/Central Markets
Distributors - Approved and Carrying
(Example: UNFI / Tree of Life

Product Information:

Future New Items:

We Must receive the following in order for your line to be reviewed:

Mail Samples & Presentation Packet To:
Grocery/Refrigerated/Frozen ONLY:
Presence Marketing/Dynamic Presence
Attn: Liz Ahern
12 Executive Court, Suite 1
South Barrington, IL 60010		        Nutrition/Body Care ONLY:
Presence Marketing/Dynamic Presence
Attn: Kelly Follmar
12 Executive Court, Suite 1
South Barrington, IL 60010

Email To: needrepresentation@pmidpi.com
*Ingredient Listing
*Price List (SRP's)
*Promotional/Marketing Plan
(Demos/Ads/Hip Pocket Deals)
Additional Comments:


I understand that in order to have my brand reviewed, all of the above information
must be received by Presence Marketing.



Presence Marketing/ Dynamic Presence