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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
For validation purposes, please share with us your LinkedIN profile URL
Company
(Required)
Number of Buyers
(Required)
1-2
3-10
11-20
21-50
50+
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)
Select
Buyer (On-Premise)
Buyer (Off-Premise)
Supplier Diversity Procurement Manager
Please select from the following:
(Required)
Select
Restaurant
Hotel
Bar
Casino
Club
Stadium
Other
Please specify:
Please select from the following
(Required)
Select
Grocery
Wine, Spirits, Beer Retailer
C-Store
eCommerce
Other
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
No
If Yes, permission to use
First Name, Last Name, Title, Company
First Name, Title, Company
First Name, Company
Title, Company
Supplier Register
Brands
Price:
Hidden
brand_data
Name
(Required)
First
Last
Email
(Required)
Phone Number
(Required)
Company
(Required)
Job Title
(Required)
Administrator
Your Diverse Powered Brands account Administrator will be given admin access to the marketplace and will be responsible for creating and managing your company and brand pages.
Admin Name
(Required)
First
Last
Admin Email
(Required)
Credit Card
Card Details
Cardholder Name
Promo Code
Total
