Retailer Questionnaire

Retailer Questionnaire

Your store submitted coupons to Arrowhead for one or more of the manufacturer brands we represent. In order to release payment to you for these transactions, we must first verify the existence and/or status of your business. Complete in its entirety.

"*" indicates required fields

Street Address*
PO Box (Optional)
Product Line*
Check all that apply.
Store Class of Trade*
Check one.
By signing below, I certify that the answers to the above questions are true. I further acknowledge that any false information provided on this form with the intent to receive payment unlawfully will be considered as fraudulent and can therefore be prosecuted in a court of law.
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Arrowhead Promotion
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