Stock Recommendation and Price Target

							                                      PROSPECTIVE VENDOR APPLICATION



                                         INSTRUCTIONS
                                                        ShopNBC
   Please return application form,
                                       ATTN: New Vendor Department/ VP of Business
detailed product information and a                    Development
          photo of your product to:               6740 Shady Oak Road
                                                 Eden Prairie, MN 55344
                         Applications are reviewed on a weekly basis.
             Approved prospects will be contacted to begin the New Vendor Process.
                                      COMPANY INFORMATION
                            NAME:

                            TITLE:

                 COMPANY NAME:

           COMPANY PRESIDENT:

                   KEY CONTACT:

           INSURANCE COMPANY:

 DOLLAR AMOUNT OF COVERAGE:
                                      CONTACT INFORMATION
              MAILING ADDRESS:



                        PHONE #:

                            FAX #:

                 EMAIL ADDRESS:
                                      PRODUCT INFORMATION
        DEPARTMENT/CATEGORY:

                  PRODUCT LINE:



                       SPECIALTY:



         AVERAGE PRICE POINTS:

              TARGET CONSUMER:

                          SELL TO:

                  BUSINESS TYPE:

                     OTHER TYPE:

                 YEARLY VOLUME:



                                            ddf6b682-6e5e-4417-b217-1e03b441432c.xls - Revised 9/20/2011
                                     TO BE COMPLETED BY SHOPNBC

         DATE RECEIVED                      APPROVED for Set-Up              FORWARDED TO              DATE


                                             Additional Information
                      Shipping Address:




                       Returns Address:




                          Units of Hand:

                             Lead Time:

  Patents, Trademarks, etc (please list):



       TV/ DRTV Exposure (please list):



                                                   Product Claims:
                                            (L-Label/ V-Verbal/ O- On Air)
                     Note: List each claim (up to 10) and what study confirms the claims usage.


1.)


2.)


3.)


4.)


5.)


6.)


7.)


8.)


9.)


10.)



                                                      ddf6b682-6e5e-4417-b217-1e03b441432c.xls - Revised 9/20/2011
                                                                    SHOPNBC VENDOR APPROVAL REQUEST
                                                                                        VENDOR #:
                                                                                        (For Internal ShopNBC Use ONLY)




                                                         VENDOR LEGAL INFORMATION
VENDOR LEGAL ENTITY NAME:                                                               PHONE:


DBA NAME:                                                                               D&B#:


STREET ADDRESS:                                                                              (Please provide most recent 12 month financials: P&L, Cash Flow Statement
                                                                                                              and Balance Sheet if D&B is not available.)
CITY:                                      STATE:                    ZIP:               STATE OF INCORPORATION:


COUNTRY:                                                                                YEARS IN BUSINESS:


URL/WEBSITE:                                                                            TAX ID#:


                                                                                        ANNUAL SALES VOLUME($'S):




                                               VENDOR OFFICERS/PARTNERS/OWNERS
NAME:                                                                                   TITLE:


NAME:                                                                                   TITLE:


NAME:                                                                                   TITLE:




                                                         VENDOR BANK INFORMATION
BANK NAME:                                                                              BANK ADDRESS:


CONTACT:                                                                                BANK PHONE:




                                                                 VENDOR REFERENCES
        Please list company name, contact name and phone number for a minimum of two(2) companies for which the vendor currently fulfills or recently fulfilled orders.
COMPANY NAME:                                                                           COMPANY NAME:


PAYABLES CONTACT:                                                                       PAYABLES CONTACT:


PHONE:                                                                                  PHONE:


MONTHLY VOLUME (UNITS & $):                                                             MONTHLY VOLUME (UNITS & $):




                                                          FINANCE RECOMMENDATION
                                              APPROVED                   NOT APPROVED                    NOT APPLICABLE
FINANCE COMMENTS:




                                                             INVENTORY DISPOSITION
GUARANTEE SALE TERMS:                                     STOCK BALANCE AGREEMENT:                                     CUSTOMER DEFECTIVES:




                                                                                   Page 3                           ddf6b682-6e5e-4417-b217-1e03b441432c.xls
                                            GENERAL VENDOR CONTACT INFORMATION
                      Used to communicate changes to policy, procedure and vendor manual updates. Vendor will be responsible for internal distribution.
CORPORATE NAME:                                                                         PAYMENT NAME:


STREET ADDRESS:                                                                         STREET ADDRESS:


CITY:                                      STATE:                    ZIP:               CITY:                                       STATE:                    ZIP:


PO CONTACT NAME:                                                                        PAYMENT CONTACT:


CONTACT PHONE:                                                                          PAYMENT PHONE:


CONTACT FAX:                                                                            PAYMENT FAX:


CONTACT EMAIL:                                                                          PAYMENT EMAIL:




                                             VENDOR MANUAL CONTACT INFORMATION
                                                    Please identify contact for online access to the ShopNBC vendor manual.
VENDOR MANUAL CONTACT NAME:                                                             VENDOR MANUAL CONTACT PHONE:


VENDOR MANUAL EMAIL:




                                                RETURN MERCHANDISE INFORMATION
STREET ADDRESS:                                                                         COUNTRY:


CITY:                                      STATE:                    ZIP:               PHONE:


CONTACT NAME:                                                                           FAX:


RETURN CONTACT EMAIL:




                                                     SHOPNBC CONTACT INFORMATION
                                            Please identify the Buyer & Merchandise Coordinator you're working with at ShopNBC.
BUYER NAME:                                                                             MERCHANDISE COORDINATOR NAME:




                                         VENDOR INFORMATION RELEASE AGREEMENT
               The undersigned vendor authorizes banks, creditors and trade references to release all information requested with respect to this application with
                  the understanding that the information will be used by the finance department to investigate matters pertaining to financial responsibility.
                                          The undersigned also hereby agrees to abide by all pertinent ShopNBC corporate policies.
SHOPNBC VP or DMM SIGNATURE:                                                            VENDOR AUTHORIZED OFFICER SIGNATURE:


PRINT NAME:                                                                             PRINT NAME:


DATE:                                                                                   TITLE:


                                                                                        DATE:




                                                                        INSTRUCTIONS
                                                    Forward signed copy of this form with attachments to:


                                                                      ShopNBC Merchandising
                                                                       6740 Shady Oak Road
                                                                      Eden Prairie, MN 55344
                                                                        ATTENTION BUYER:




                                                                                    Page 4                           ddf6b682-6e5e-4417-b217-1e03b441432c.xls