SMART Solutions:
Join SMART today by using the form below:
What type of business are you?
*
Restaurant
Senior Living Facility
Lodging & Travel
Convenience Store
Other
How many locations will be reporting?
*
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:
*
Decision Maker's First Name:
*
Decision Maker's Last Name:
*
Decision Maker's Email Address:
*
Decision Maker's 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
Please provide your GPO name:
*
Do you have any direct agreements?
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Yes
No
Please list your direct agreements:
*
Distributor OpCo:
*
Distributor Account Number:
*
Distributor Sales Representative Name:
*
Distributor Sales Representative Email:
*
Distributor Sales Representative Phone Number:
*
Best date and time to meet:
Any other feedback you wish to provide?
New member authorizes Buyers Edge Platform to fill out their LOP:
*
Yes
No
Signature
Digital Signature Name
*
First Name
Last Name
Digital Signature Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: