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BENTON·KIRBY NEW PRODUCT PROPOSAL

Return completed form and samples to:

NOTE: To ensure that your product will be given proper consideration, you MUST include this proposal sheet with each sample being submitted AND include a NAFTA Certificate of Origin Document, plUS, when required, a Material Safety Data Sheet. A current copy of your product liability certificate of insurance, naming Triarco as an additional insured via broad-form vendor's liability endorsement, is required on file at Triarco.

Supplier Name:____________________________________________________________________________ Address:__________________________________________________________________________________ __________________________________________________________________________________________ Phone: ___________________________________________________________________________________ FAX: _____________________________________________________________________________________ Website Address __________________________________________________________________________ Amount Per Order/Minimum Qty./$: __________________________ Invoice Terms: _____________________________________________

BENTON·KIRBY ATTN: Carla King 2600 Fernbrook Lane, Suite 100 Plymouth, MN 55447 763-551-2158, ext 120 · FAX 763-559-2215

Contact/Representative Name: _____________________________________________________________ Address (if different): ______________________________________________________________________ _________________________________________________________________________________________ Phone (if different): ________________________________________________________________________ FAX (if different): __________________________________________________________________________ E-mail: ___________________________________________________________________________________ Freight Terms: _____________________________________________ Shipping Point:_______________ Zip/Postal Code _____________

Advertising Allowance: __________ % Order shipped in __________ days

PRODUCT INFORMATION: Complete one form per product being submitted. Product Number (L)

*Vendor

*Product Description (B)

*

Vendor Std. Purchase (J)

*These are Required Fields. Product will not be accepted until complete. Master *B/K *Vendor Std. List *Vendor *Master Purchase *Vendor Case Qty. Quoted Suggested Carton Carton

Weight U/M (H) Price (O) Price Cost (M) Quantity Retail

Bolded boxed in areas for Benton·Kirby use only

B/K Catalog Number (A)

Benton-Kirby Description (if different)

B/K Sell U/M (G)

B/K Unit B/K Catalog Target Quantity Ship Weight Sell Price Margin % Discount (N) (P) (I) Break

Quantity Sell Price

Quantity Target Margin

B/K Cost

B/K Suggest Retail

Other Notes:

Vendor Number (K)

Minimum Purchase Quantity

Section (C)

Purchase Conver. Quantity

Class (D)

Catalog Page No. (F)

*UPC Code Required *Country of Origin: *Fabric:

Y

Made in U.S.A. Other ___________________________ MUST ATTACH NAFTA CERTIFICATE OF ORIGIN Appropriate Grade Level(s): __________ Copyright Date (Books): _______________________ Die Cast Metal Glass

Made in China Made in Taiwan _________________________________ Product Dimensions: Imported Product Manufactured of:

U.S.A. U.S.A. & Imported Soft Vinyl Hard Vinyl Lucite Acrylic Molded Resin Porcelain __________________________ Other Electrical: U/L Cord On/Off Switch Batteries ( Included Required; Quantity _______ Size _______ ) Product Packaging: Bulk Individual per Polybag Assorted per Polybag Blister Card Gift Boxed Individually Shrinkwrapped Peg Hang Card Candy/Food Products: Recommended Shelf Life ________________ Date Code stamped on Master Carton? Yes

Counter Display Box No Certified Kosher

Products containing liquid or considered cosmetics require a Material Safety Data Sheet (MSDS) and must be submitted with this product proposal. Can you provide a digital image of product submitted? Yes No Sample Received __________ Image Received _________ Name of Person Submitting Data: __________________________________________________________ Date ________

PRINTED IN U.S.A. NP 112-02/RV 5-07

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