Merchants Distributors, Inc.
Note to Vendors: Please complete BOLD & ITALIC FACE areas only then answer the questionnaire on page 3.
MDI ITEM CODE DESCRIPTION
MDI DESC (24) New Item Ship Date
LINE 2 DESC (40) New Item Order Date
SHORT DESC (17) New Item Arrival Date
VENDOR NO. VENDOR NAME
UPC NC 5-DIGIT EXPANDED: MFG CASE ITEM Accrual Amount
6-DIGIT SUPPRESSED UPC: Accrual Percent
------------AND--------------- Rebate Percent
Purchase GTIN (14 digits): Rebate Type
Retail GTIN (14 digits):
PHYSICAL ATTRIBUTES BUYING INFORMATION COST/PRICE INFORMATION
********************* * * * (SEE BACK FOR DEFINITIONS) * * * *************
PACK MST CASE BUYER NO. MERCHANDISER NO. NET PRICE FLAG (C)
INNER PACK MFG BUY UNIT ITEM UPDATE (Y) PO COST (Delivered)
SIZE UOM PRODUCT DATING Type: Julian or Standard PO COST (FOB)
MST PK WT COMMODITY FORECAST MODEL DISCO REASON CUST CS COST
MST PK CUBE SUB-COMM CONTROL FLAGS ENTER "Y" OR "N" OR TAKE DEFAULT "A" PRICE
CASE DEPTH UNIT DEPTH CIGARETTE ITEM (N) BREAKDOWN PK (Y) CENTS OFF
CASE WIDTH UNIT WIDTH PALLET ITEM (N) ORDER BOOK PRINT (Y) PRE-PRICE AMT
CASE HEIGHT UNIT HEIGHT NEW ITEM REPORT (N) SHELF TAG (Y) DEAL PACK (R)
MFG PALLET SIZE MFG TI J-HOOK (N) AUTO RETAIL UPDT (Y) SUB-ITEM NUMBER
MFG HI SAUERS (N) SHIPPER/DISPLAY (N)
COF/CAW MCCORMICK (N) HAZARDOUS MATL (Y) DRC FLAG (Y, N, S)
PRIVATE LABEL (N) DRUG TAX EXEMPT (N) RECLAIM SWELL TYPE
CLASS WAREHOUSE PL CODE (Y) DRC FLAG (Y) (A=Cents per, P=% of cost)
CATEGORY GROUP (IF PRIVATE LABEL IS "Y") GOURMET FLAG (N) RECLAIM SWELL AMOUNT
DEA REPORT FLAG (N) ORGANIC FLAG (N) VENDOR RECLAIM AMOUNT
INSD MRGN GRP# HISPANIC FLAG (N) BOOKING ONLY (N)
ORDER UNIT NATURAL FLAG (N) HM CODE (Y) SRP ZONE 1
Bioterrorism Code (IF HAZ. MTL. IS "Y")
SLOTTING $ NOTE: INCORRECT UPC INFORMATION WILL RESULT IN A $1,000 FINE. ALL OTHER
PAY METHOD: INCORRECT INFORMATION COULD RESULT IN A $500 FINE.
ESTIMATED MOVEMENT: (CS WEEKLY) ABOVE ITEM IS REPLACEMENT FOR :
IT IS MUTUALLY UNDERSTOOD THAT A COMPANY SHOULD STAND BEHIND IT'S PRODUCTS AND WORK FOR DISTRIBUTION. IN THE EVENT AGREED UPON MOVEMENT
IS NOT GENERATED ON ITEMS LISTED IN 120 DAYS, THE MANUFACTURER AGREES TO REMOVE THE PRODUCT FROM THE WAREHOUSE AT NO COST TO MDI.
VENDOR SIGNATURE TWO LIVE SAMPLES ARE REQUIRED OF ALL NEW ITEMS.
MERCHANTS DISTRIBUTORS, INC.
NEW ITEM PRESENTATION AND AGREEMENT DATE:
This information must be filled out completely!
CASH DISCOUNT: PERCENT DAYS DAYS NET.
IS CASE COST FOB OR DELIVERED MINIMUM SHIPMENT VENDOR LEAD TIME
TAXABLE PRODUCT: Petroleum Tax NC TAX SC TAX TN TAX GA TAX WVA TAX VA egg TAX
IS PRODUCT PRODUCED OR PACKED IN NC? WHO WILL BE THE FIRST RECIPIENT OF THIS PRODUCT?
* SIGNATURE: DATE:
INTRODUCTORY ALLOWANCE: AMOUNT FIRST SHIP LAST ORDER LAST SHIP
NEXT ALLOWANCE & DATES:
ADDITIONAL MONIES AVAILABLE AT RETAIL LEVEL:
ARE FREE GOODS AVAILABLE FOR INITIAL DISTRIBUTION?
TRANSPORTATION: IF COMMON CARRIER IS USED, SHIP VIA MERCHANTS TRANSPORT OF HICKORY (704) 323-4240 OR (704) 323-4289
POINT OF ORIGIN:
MDI VENDOR/BROKER MAINTENANCE FORM SHOULD BE ATTACHED TO NEW ITEM FORM, IF MDI DOES NOT CURRENTLY BUY FROM VENDOR OR WHEN CHANGES ARE NECESSARY.
VENDOR NAME BROKER: PHONE:
PLEASE NOTE THE FOLLOWING:
WE FEEL AS A GROCERY WHOLESALER, CERTAIN TOPICS SHOULD BE COMMONLY AGREED UPON:
1) A LATE DELIVERY FEE OF $200 PER DAY WILL BE CHARGED FOR ALL LATE DELIVERIES.
2) FREE CASES ARE EXTREMELY EFFECTIVE IN SECURING DISTRIBUTION. DO YOU HAVE FREE CASES AVAILABLE? YES NO
3) PRICE DECLINES: WILL YOU PROTECT EXISTING INVENTORY? YES NO
4) WILL YOU MAINTAIN SHELF SPACE AT RETAIL LEVEL BY: STORE CHECKS, ATTENDING STORE SETS AND STORE REMODELING? YES NO
* SIGNATURE OF ABOVE PERSON INSURES CORRECT AND COMPLETE INFORMATION. INCORRECT OR ERRONEOUS INFORMATION WILL RESULT IN FINES
TO YOUR COMPANY. SIGNATURE OF ABOVE PERSON ASSUMES RESPONSIBILITY OF EXISTING INVENTORY AND ANY OUTSTANDING BILL-BACK OR INDEBTEDNESS.
PACK > MDI selling unit.
MST CASE > If this item is sold in quantities less than the master pack, MASTER CASE is the ratio between the selling unit and the master pack.
UM > Acceptable characters are OZ, LB, EA, GR, IN, CT, FT, ML, YD, CC, SF, MM, OT, AL, PF.
CS U FACTOR > For those vendors, primarily paper manufacturers', who determine brackets not on the basis of pounds, cases, dollars, cubes, pallets
or dozens, this is the independent factor used in determining the credit towards a maximum or minimum.
MFG BUY UNIT > 0) - Any quantity can be ordered, 1) - purchase must be made in manufacturers' layers, 2) - purchase must be made only in
PRODUCT DATING > The number of days an item can be stored in the warehouse and still maintain it's quality.
P.O. COST > The price for the bracket in which MDI would normally purchase this item.
COMPONENTS CONTAINED IN DISPLAY:
Fields PACK, SIZE, UOM, UNIT COST AND
Fields CODE, ITEM DESCRIPTION, UPC, QTY, AND CASE/UNIT are required on all components. RETAIL READY are rquired on non-stocked
C=Case UNIT READY
CODE ITEM DESCRIPTION Retail GTIN UPC QTY U=Units PACK SIZE UOM COST Y/N
MERCHANTS DISTRIBUTORS, INC. 3
SALES TAX QUESTIONNAIRE DATE:
Instructions: Indicate the category this item falls into then mark all answers that apply within the category
Dietary supplements, Nonprescription drugs and Remedies
This product has a “Supplement Facts” box . This product is classified as a vitamin or a mineral
This product has a “Drug Facts” box . This product is classified as a toilette article advertised or held out for
This product is classified as a cosmetic article (applied to the body for sale for grooming purposes (soaps, toothpastes, hair sprays, shaving
cleansing, beautifying, promoting attractiveness or altering the products, colognes, deodorants and mouthwashes)
appearance) This product is used as diet aide or weight control preparation
This product is classified as a device – includes contraceptive items, birth This product is classified as a diabetic testing kit
control or testing kits . This product contains one or more of the following ingredients: an
This product is classified as a remedy as listed in FL DR-46NT (see herb or other botanical, amino acid, any substance for use by humans to
current list at: http://dor.myflorida.com/dor/forms/2010/dr46nt.pdf ) supplement the diet by increasing the total intake or a concentrate,
This product is a substance or mixture of substances containing metabolite, constituent or a combination of these AND it is not represented
medicines or drugs for which no prescription is required or proprietary as conventional food AND it is not represented for use as a sole item of a
medicine purchased for the cure, mitigation, treatment, or prevention of meal or of the diet
disease in human beings
2. Eggs (check only one)
This product is classified as a shell egg This product is classified as boiled, pickled, or preserved egg
This product is classified as liquid egg This product is classified as sliced, diced, or chopped egg
This product is classified as dried egg – whole or yolk This product is classified as dried albumen
This product is classified as fortified blend
This product is a substance, whether in liquid, concentrated, solid, frozen, dried This product is a preparation of sugar, honey or other natural or artificial sweeteners
or dehydrated form, that is sold for ingestion or chewing by humans and is in combination of chocolate, fruits, nuts or other ingredients or flavorings in the form
consumed for its taste or nutritional value of bars, drops, or pieces
This product is included in one of these categories: jams, jellies, honey, This product is classified as a “similar candy item”, commonly purchased by its
preserves, syrups, frosting, dried fruits, breakfast cereals, prepared fruit in sugar sweet taste: jelly beans, granola bars, chocolate-coated or candy-coated peanuts,
or similar base, candy primarily intended for decorating baked goods cookies or pretzels
This product is classified as seed or plant intended to grow food This product is classified as food or vegetable coloring
This product is intended and sold for cooking purposes This product contains flour
This product is gum or breath mint This product requires refrigeration
This product is classified as “prepared food” (meals sold at the store for the This product is intended or sold for animal consumption or marketed as pet food
purpose of eating at or near the store) This product is classified as ice (including dry ice)
This product is classified as ice cream, frozen yogurt, and similar frozen dairy
and nondairy products in cones, small cups or pints, popsicles, frozen fruit bars
or other novelty item
This item is a lubricant
Continue in the back
5. Tobacco (check only one)
This product is classified as a moist snuff product This product is classified as cigarettes.
This product is classified as a dry snuff product Number of cigarettes per individual pack:
This product is classified as Roll Your Own cigarette This product is classified as loose or smokeless tobacco – other then snuff, Roll
This product is classified as pipe tobacco Your Own cigarette and pipe tobacco
This product is classified as Large cigars. This product is classified as any other product that contains tobacco and is intended
This product is classified as Small cigars. for inhalation or oral use.
Number of cigars per individual pack:
6. Beverage & Juices
This product is fluid milk to which NO flavoring has been added This product has alcohol suitable for human consumption and contains at
This product is fluid milk to which flavoring has been added least one half of one percent of alcohol by volume
This product contains soy, rice, any milk substitutes or milk derivatives This product is classified as natural undiluted fruit juice, cider or vegetable
This product can be classified as any noncarbonated drink made from juice (100% pure and contains no artificial or natural sweeteners, flavorings
milk derivatives or tea, when sold in cans or similar containers or preservatives)
This product is labeled as “baby formula” . This product is fruit juice, cider or
This product has natural or artificial sweeteners vegetable juice. Percent of juice: ________ This product is classified pure
. This product is classified as “bottled or canned soft fruit juice concentrate to which no additive has been made and requires only
drink” . This product is classified as bottled or canned drink, water necessary to restore the juice to its natural state
ade or punch (finished drink) This product is classified as a
This product has any of the terms: „ade‟, „drink‟ or coffee or coffee substitute or cocoa . This product is classified as a
beverage before or after or in conjunction with the name “powder-based” pure tea with no sweeteners and /or no flavoring
This product is classified as a cocktail mix This product is
. This product has any carbonated or mineral added classified as a “powder-based” drink . This
. This product is classified as plain non-carbonated product is classified as a “powder-based” breakfast drink, chocolate or malt-
water . This product is classified as flavored water flavored (without any additional flavoring added) This
. This product is classified as naturally product is classified as tea and sold in liquid form . This
carbonated water product is classified as syrup, shake-base, drink base, frozen concentrate or
Bottled Soft Drinks – “Bottled Soft Drinks” shall include any and all non-alcoholic beverages whether carbonated or not, such as soda water, ginger ale, Coca Cola,
lime cola, Pepsi Cola, Dr. Pepper, root beer, carbonated water, orangeade, lemonade, fruit juice when any plain or carbonated water, flavoring or syrup is added, or
any and all preparations commonly referred to as “soft drinks” of whatever kind which are closed and sealed in glass, paper, or any other type of container, envelope,
package, or bottle, whether manufactured with or without the use of any syrup. The term “bottled soft drinks” shall not include fluid milk to which no flavoring has been
added, or natural undiluted fruit juice or vegetable juice. (Note: This included coffee and tea when canned or bottled as a soft drink.) The term “bottled soft drinks” also
does not include plain water that is not carbonated artificially, but which is naturally carbonated before it is removed from the ground, and to which no additional
carbonation has been added.
None of the above statements apply to this product
Product Identification: Description:
Purchase GTIN: UPC:
VENDOR NAME BROKER: PHONE:
Electronically Mark this field to signify your agreement that this document represents, to the best of your knowledge,
SIGNED: your company answers to this questionnaire and it applies to the item identified above.
Your NAME: DATE: