SMART Solutions:
Join SMART today by using the form below:
What type of business are you?
*
Restaurant
Hospitality / Lodging
Senior Living Facility
Convenience Store
Other
How many locations will be reporting?
*
Are you participating in any other GPO?
*
Yes
No
Business Location Name:
*
Business Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Decision Maker's First Name:
*
Decision Maker's Last Name:
*
Decision Maker's Full Name
*
First Name
Last Name
Decision Maker's Title:
*
Decision Maker's Email Address:
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to contact?
*
Phone
Text
Email
Decision Maker's Phone Number:
*
Customer Account Number:
*
Est. Weekly Sales Volume:
*
Distributor Name / City & State
*
Distributor Sales Rep Name:
*
Best date and time for a follow up phone call:
Is there additional information you would like to include?
New member authorizes Buyers Edge Platform to fill out their Letter of Participation (LOP):
*
Yes
No
Signature
Digital Signature Name
*
First Name
Last Name
Digital Signature Date
*
-
Month
-
Day
Year
Date
Submit
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