Request for Retailer / Foodservice Registration

Name*

First NameLast Name

Company Name*

Job Title*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

PACA License*

How many Stores or Distribution Locations does this Company own? *

List Addresses of Stores or Distribution Locations:*

Supermarket Retailer or C-Store Operators: A full-service retail chain that sells food to consumers. Must have at least 3 stores or more. Buyers with single locations are open to inclusion at the discretion of the Texas International Produce Association (TIPA).Foodservice Distributor: A company that provides food and non-food products to restaurants, cafeterias, industrial caterers and hotels via multiple physical locations which receive the product and then distributes direct to the aforementioned channels.Foodservice Operator: Includes restaurants, hotels, industrial caterers, cafeterias and meal box subscription companies which receive product for final use.Wholesale Distribution Operators: includes full-service retailer/foodservice distributors that provide comprehensive fulfillment services to retail and foodservice operators through multiple locations and outlets under the parent company. (Does not include buying offices, terminal markets, commission merchants, buying brokers etc.).Other

Yes – I would like to request travel assistance (hotel and/or airfare)No – I do not need hotel or airfare assistance

Retailer / Foodservice Registration Request Form