Dis-Chem In-Store Promoter Bookings Form

In-Store Promoter Bookings Form

This form must be completed by all Vendors booking in-store promotions

Start Date*

MonthDayYear
End Date

MonthDayYear
Campaign Duration (Weeks)*
only counts weeks that have activations
Number of Stores to be Booked*
Total number of stores to be activated in
Total Number of Activation Days*
e.g. based 20 Stores x 2 weeks x 2 Day
Store Rotation or Change*
Stores maybe changed weekly
Please explain Store Rotation or Changes (if applicable)
Preferred Positioning*

in Aislebefore Snake Queueat Front of Store (special permission required)Other
If you elected "Other" above please share details

Branding Elements

Our Commitment

XP Squared Proprietary Limited (its partners and affiliates) are committed to maintaining the accuracy, confidentiality, and security of your personally identifiable information ("Personal Information"). As part of this commitment, our privacy policy governs our actions as they relate to the collection, use and disclosure of Personal Information and the information provided herein above shall be utilised strictly for the processing of this requisition; and in doing so some or all of the above may be shared with Dis-Chem Pharmacies Limited. For more information please visit https://www.xp2.co.za/privacy-policy.
Acknowledgement*

I am duly authorised by the company, as listed above, to act on behalf of the company in this matter.I understand that information required herein above is essential for the processing this requisition and consent to XP Squared and/or Dis-Chem utilising this information for such purpose.I consent to my contact details being shared with XP Squared and Dis-Chem personnel (as necessary) in order that this requisition be processed.I am aware that this requisition does not guarantee or commitment of approval.
Date

DayMonthYear
Should be Empty:

Company Details