Preferred Supplier Program Details Preferred Partner Program Details Please complete this form with the requested program details. Thank you for your partnership! Step 1 of 7 14% Supplier Name* ASI#* PPAI#* Vernon Account #*Supplier’s internal number for referencing the Vernon account Supplier Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PO Email*The email address to which Vernon sends POs. Artwork Email*The email address to which Vernon sends artwork. Sample PO Email*The email address where sample requests are to be sent. CONTACT INFORMATION National Account ManagerThe contact person for Vernon’s Vendor RelationsName – National Account Manager* Email – National Account Manager* Phone – National Account ManagerPlease enter (###) ###-#### plus ext. #### if applicable Account Rep/Internal SupportThe contact person for Vernon account execs – if different from National Account Manager. If you have a list of Regional Account Reps, please send to Alex Vernon.Name – Account Rep Email – Account Rep Phone – Account RepPlease enter (###) ###-#### plus ext. #### if applicable Dedicated Customer Service RepName – CSR* Email – CSR* Phone – CSRPlease enter (###) ###-#### plus ext. #### if applicable Safety & Compliance ManagerName – Compliance Manager* Email – Compliance Manager* Phone – Compliance ManagerPlease enter (###) ###-#### plus ext. #### if applicable Accounts Receivable ContactName – Accounts Receivable* Email – Accounts Receivable* Phone – Accounts ReceivablePlease enter (###) ###-#### plus ext. #### if applicable PRICING & PROGRAM INFORMATIONPlease list the pricing information for The Vernon Company. Be specific – include any/all exceptions or exclusions. Pricing Commitment to Vernon*Example: EQP pricing on all catalog quantities. If special pricing is given for setup charges or other extra fees, please include that information here.Corporate Program Pricing for Vernon*If you have special pricing, lowered minimums, waived set-ups, etc. for programs, include that information here.Digital/Email Proof Policy*As a preferred partner Vernon expects digital/email proofs to be provided at no charge.Random/Blank Sample Policy*Spec Sample Policy*Pre-Production Proof Policy*Self Promo Policy*PAYMENT TERMSVernon participates in early payment discounts when available.Do you offer an early payment discount program that will not impact Vernon's rebate program?* Yes No Details of early pay discount program, if applicable.What are your payment terms for Vernon? (e.g. 1%/10, Net 30)* COMPANY INFORMATIONUSA Made Yes No Union Made Yes No Custom Importing Yes No Retail BrandsPlease list any retail brands available in your line. Product LicenseeDo you hold licensing agreements with any associations, organizations, companies, schools, etc. WEBSITE RESOURCESSupplier Website* How do Vernon AEs access your web resources?Do they need a log-in, or simply visit your website to access available tools?Log-in details, if needed.MARKETING RESOURCESOf the following marketing tools, please check all that are available to Vernon. Select All Virtuals Custom Flyers Presentations/Storyboards Digital Catalogs Print Catalogs Exclusive Vernon Special Offers High-Res Images Available on your Website Digital catalog link Additional creative services and marketing tools available SUSTAINABILITY & CHARITABLE PROGRAMSDo you participate in Social/Environmental Responsibility Programs? Please list and explain.Do you participate in Charitable Giveback Programs? Do sales from any products in your line go to a charitable organization? Please list and explain.PRODUCT SAFETYTo be included in our preferred partner program suppliers must agree to and sign Vernon’s product safety and social compliance requirements, in which you provide a General Product Safety Position Letter, Social Compliance Agreement, Indemnification Agreement and Proof of Insurance (sent separately).By checking the box below you agree that terms and provisions of the contract are valid for this fiscal sales year* Agree, all terms of current safety & compliance contract remain in effect for this fiscal sales year Don’t Agree If you checked Don't Agree, please explain.Vernon expects all preferred program partners can provide a General Certificate of Conformity (GCC) or testing documentation for any product in it’s line, when requested.Check here if you are able to provide GCCs/CPCs or testing documentation for each product in your line.* Yes No WELCOME PROGRAMWhen a new AE joins The Vernon Company, they can choose to receive a welcome kit from our preferred suppliers who participate in this program. The kits can include product samples, catalogs and other collateral. The supplier ships the Welcome Kit directly to the AE when one has been requested. Participation in this program is voluntary. Please note: These kits are to be sent at no charge for items or shipping.Will you be participating in the Welcome Program?* Yes No Please list the products included in your Welcome KitWelcome Kit Contact Welcome Kit Email Completed ByName Company Email* PhonePlease enter (###) ###-#### plus ext. #### if applicable CAPTCHA