Buyer Intake - Diverse Powered Brands

Buyer Access Form

Exploring the Diverse Powered Brands™ digital catalog is accessible only to qualified buyers and supplier diversity managers to easily identify diverse suppliers in the beverage alcohol industry. Please submit your request below.

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Job Title(Required)

How did you hear about us/Referred by:

LinkedIN Profile URL(Required)

For validation purposes, please share with us your LinkedIN profile URL. If you do not have a LinkedIN, please share another digital source of confirmation (ie: you bio on company website).

Company(Required)

Number of Buyers(Required)

Store Count(Required)

Coverage Area(Required)

i.e.:U.S. national buyer, U.S. specific region, Canada, France, etc.

If U.S., in what state are you located?

What is Your Position Type?(Required)

Please select from the following:(Required)

Please specify:

Please select from the following(Required)

Please specify:

If U.S., what distributors do you use?

Why are you interested in the Diverse Powered Brands and how will it assist your business goals?(Required)

Permission to use statement above as a testimonial on website, press release, media?(Required)

Yes

If Yes, permission to use

First Name, Last Name, Title, Company

First Name, Title, Company

First Name, Company

Title, Company

CAPTCHA

Buyer Login Request

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Job Title(Required)

How did you hear about us/Referred by:

LinkedIN Profile URL(Required)

For validation purposes, please share with us your LinkedIN profile URL. If you do not have a LinkedIN, please share another digital source of confirmation (ie: you bio on company website).

Company(Required)

Number of Buyers(Required)

Store Count(Required)

Coverage Area(Required)

i.e.:U.S. national buyer, U.S. specific region, Canada, France, etc.

If U.S., in what state are you located?

What is Your Position Type?(Required)

Please select from the following:(Required)

Please specify:

Please select from the following(Required)

Please specify:

If U.S., what distributors do you use?

Why are you interested in the Diverse Powered Brands and how will it assist your business goals?(Required)

Permission to use statement above as a testimonial on website, press release, media?(Required)

Yes

If Yes, permission to use

First Name, Last Name, Title, Company

First Name, Title, Company

First Name, Company

Title, Company

CAPTCHA

Buyer Access Form

Buyer Login Request

Supplier Register

Administrator