Buyers Edge Platform Solutions:
Join Dining Alliance, Source1, PRIME Services, or SaveMore today.
What type of business are you?
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Restaurant
Senior Living Facility
Lodging & Travel
Convenience Store
Other
How many locations will be reporting?
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Business Name:
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Business Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number:
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-
Area Code
Phone Number
Decision Maker's First Name:
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Decision Maker's Last Name:
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Decision Maker's Email Address:
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Decision Maker's Phone Number:
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Area Code
Phone Number
Best way to contact?
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Phone
Text
Email
Are you participating in any other GPO?
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Yes
No
Provide your GPO name:
Do you have any direct agreements?
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Yes
No
Provide a list your direct agreements:
Provide your GPO name:
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Distributor OpCo:
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Distributor Account Number:
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Distributor Sales Representative Name:
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Distributor Sales Representative Email:
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Distributor Sales Representative Phone Number:
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-
Area Code
Phone Number
Best Date and Time to contact customer:
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Any other feedback you wish to provide?
New member authorizes Buyers Edge Platform to fill out their LOP:
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Yes
No
Signature
Digital Signature Name
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First Name
Last Name
Digital Signature Date
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-
Month
-
Day
Year
Date
Submit
Should be Empty: