VENDOR FORM

Name *

First Name

Last Name

Phone *

(###)

###

####

Status *

Broker

Distributor

Producer

Distribution *

I use a distributor

I self-distribute

Headquarters *

In not applicable please enter N/A

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Local? *

We love to partner with local producers and makers. If you are headquartered locally and would like to be added to our 'Locally Made' category please select 'Yes' below.

Yes

No

Category

Please select the category that best describes your product

Grocery

Bakery

Alcohol

Produce/Floral

Lifestyle/Housewares

Other