Prison Blues Reseller Form

ACKNOWLEDGEMENT OF OREGON AIC-MADE GOODS
The goods you will be purchasing are produced by Oregon adults in custody (AICs) as a part of Prison Industries Enhancement Certified Program (PIECP), a federal program. Authorized dealers of Prison Blues must comply with applicable federal laws concerning the sales, transportation, shipment, and packaging of Prison Blues goods into interstate commerce, including 18 U.S.C. §§ 1761-1762.
To help Oregon Corrections Enterprises ensure dealer compliance with applicable federal and state law, please certify the type of sales you will engage in as an authorized dealer of Prison Blues:*

Sales solely within the State of Oregon. OCE products will not be resold, shipped, or travel outside of the State of Oregon.Sales with the intent to sell outside of Oregon or through eCommerce.
The parties further agree they shall notify OCE in writing if the identified usage of the product changes. This notification must occur prior to the change of use. Failure to notify OCE of a change in product use may lead to the termination of the dealer agreement.
Signature*

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Date*

MonthDayYear
Date
Name*

First NameLast Name
Title*
SALES AND MARKETING DISCLOSURE
Company Name*
I/We will be selling Prison Blues™ at a physical location*

YesNo
Location Address

Store Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Add additional location
Additional Address
I/We will be selling Prison Blues via ecommerce (If “Yes,” please provide your business URL before submitting the form.):*

YesNo
Please provide the website URL where Prison Blues™ will be listed and sold:
Select for additional website URLs
Provide the website URL where Prison Blues™ will be listed and sold
Is your business on social media?*

YesNo
Do you advertise or post about Prison Blues™ on social media?*

YesNo
Please list username next to all social media channels Prison Blues will be promoted and/or sold:
Platform
Username
Will you sell Prison Blues on this platform?

YesNoNot at this time, but may possibly in the future.
Will you advertise/promote Prison Blues on this platform?

YesNoNot at this time, but may possibly in the future.
Add additional social media account
Any other information you would like to tell us about your business?
Those are all the accounts?

Yes
Please share your contact information and our team will reach out to you:
Name*
Email*
Phone*
Signature*

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*If any of the above information changes please re-submit this form.
Please provide images of store front(s) and Prison Blues™ display(s) in your store(s) in jpeg or png format by sending them to marketing@oce.oregon.gov, and clearly labeled with the store address.
Qualifying images will be used on our vendor map where appropriate. Some editing may be required for copyright, quality, size, or other.
May we share these images on social media, this media or any media hereafter developed for the use of OCE?*

AgreeDecline
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ACKNOWLEDGEMENT OF OREGON AIC-MADE GOODS

SALES AND MARKETING DISCLOSURE