Instructions:

Please complete all sections of this application and click “Submit”. Incomplete applications may delay processing. Email any required documents (e.g., business licenses, tax forms, etc.) and include a copy of this form to sales@alpepllc.com or mail to the contact information above.

AlPep LLC Retailer Application Form
Section 1: Company Information
3. Business Address
3. Business Address
City
State/Province
Zip/Postal
4. Mailing Address (if different):
4. Mailing Address (if different):
City
State/Province
Zip/Postal
Section 2: Business Details
Section 3: Contact Information
14. Primary Contact Person:
14. Primary Contact Person:
First Name
Last Name
15. Accounts Payable Contact:
15. Accounts Payable Contact:
First Name
Last Name
16. Purchasing Contact (if different):
16. Purchasing Contact (if different):
First Name
Last Name
17. How did you hear about UniSUC? (check all that apply):
Section 4: Business Operations
18. Estimated Monthly Purchases (in # of units):
19. Do you currently distribute similar products?
21. Preferred Payment Method:
23. Any special shipping requirements?
19. Do you currently distribute similar products?
Section 5: Certifications and Agreements
23. Certifications/Licenses (check all that apply):

Agreement:
By signing below, I certify that the information provided is accurate to the best of my knowledge. I authorize AlPep LLC to verify any information provided in this application and understand that approval as a distributor is subject to review and acceptance of terms set forth by AlPep LLC.

Name:
Name:
First Name
Last Name
Section 6: Additional Information

Please provide any additional information or documents to support your application, such as references, business history, or past partnerships. Attach extra pages if necessary.

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