ATTENTION: Prime Source Manufactures We are seeking low cost - high quality supplier sources to sell to big box retailers in North America. All product categories and all countries welcome. Must be qualified to meet the needs of large retailers. Volume Capacity - Consistent Quality - Competitive Cost Pricing If you think your company meets our supply standards, contact us!

Name

First Name Last Name

Job Title:

Company Name:

Company Address:

Street Address

Address Line 2

City State ZIP

Country:

Phone Number: Fax Number:

Email Address:

Website Address:

What is the approximate number of employees in your company?:

How many manufacturing facilities do you have?:

List manufacturing facility locations:

Are you vertically integrated?:

YesNo

What are your closest shipping ports?:

At this location, what do you manufacture?:

Building Materials Hardware Hand and/or power tools Home Decor Plumbing and/or Bath Products Lawn and Garden Appliances Other (specify below)

Specify other building materials here

Annual sales volume at my location:

Over $100,000,000 $50,000,000 - 99,999,999 $20,000,000 - $49,999,999 $10,000,000 - $19,999,999 $1,000,000 - $9,999,999 $999,999 or less

Who are your primary customers?:

North America Europe Asia Other (specify below)

Specify other primary customers here

Are you EDI capable?:

YesNo

Do you have product liability insurance?:

YesNo

What are your policy limits?:

Comments: