Intake Form Home Intake Form Name* Email* Phone* Referred by* Company/brands seeking representation* Website* Please describe your value proposition and/or your key points of differentiation strategic growth needs* Organization ownership structure* Please describe your current internal sales organization* Current Distribution Annual grocery channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Annual natural/specialty channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Annual c-store channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Annual drug channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Annual mass channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Annual e-comm channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Annual club channel revenue Distributor annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Select direct annual revenue, national* Select N/A <$10MM $10MM-$50MM $50MM-$100MM $100MM-$250MM $250M+ Other channels of revenue Are there any other channels of revenue? No Yes Coverage needed* Select National Regional Channel Specific Customer Specific Services Interested in* (Check all that apply) BUILD Branding/Creative/Marketing E-Comm Retail Activation Insights Back-End Dedicated Support Sales Broker network* Select National Regional Hybrid None KeHe authorization* Select National Regional None UNFI authorization* Select National Regional None Comments 651 W Washington Blvd, Suite 1-S, Chicago IL 60661 630.539.3100 CONTACT US CAREERS STAY IN THE KNOW Email (required) * Constant Contact Use. Please leave this field blank.