Manufacturer Rebate Program

Client Information
Location Name
If you operate more than one location, please note that each location requires a unique enrollment form.
Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location Phone Number
Please enter a valid phone number.
Main Contact Name

First NameLast Name
Main Contact Title
Main Contact Email
example@example.com
Main Contact Cell Phone Number
Please enter a valid phone number.

Payment Information
All payee information will be set to the business name and checks will be mailed to the business address. Should you wish to make any changes to your payee information, please do so in this section.
Business Name on Check
Mail Check to Location Address?

YesNo
Check Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payee Contact (if different from account contact)

First NameLast Name
Payee Email (if different from account contact)
example@example.com

Distributor Information
Be sure to include all vendors where you purchase manufacturer-labeled food, cleaning supplies, and paper products, including the Restaurant Store. You do not need to include grocery stores, wholesale clubs (Sams Club, Costco, BJ's), or those vendors where only fresh items (meats, seafood, produce, etc.) are purchased.
Distributor Information*