Prison Blues Reseller Form

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:

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

Date

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Title

Legal Business Name

Federal Tax ID# or EIN

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Company Name

I/We will be selling Prison Blues™ at a physical location

Location Address

Store Name

Street Address

CityState / Province

Postal / Zip CodeCountry

Additional Address

I/We will be selling Prison Blues via ecommerce (If “Yes,” please provide your business URL before submitting the form.):

Please provide the website URL where Prison Blues™ will be listed and sold:

Provide the website URL where Prison Blues™ will be listed and sold

Is your business on social media?

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

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?

Will you advertise/promote Prison Blues on this platform?

Any other information you would like to tell us about your business?

Those are all the accounts?

Signature

*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?

ACKNOWLEDGEMENT OF OREGON AIC-MADE GOODS

SALES AND MARKETING DISCLOSURE