Fridge / Product Request Form
Ongoing product placement / seeding request form for Health-Ade marketing. All products and all fridges are going to go through this form.
Requester *
Who is making the request, Title
Your answer
Approver *
Who approved this request?
Region *
Relationship Manager *
Who will manage the relationship with recipient, Title
Your answer
Pillar *
E.g. Other - Athletes
Recipient *
Person / Business receiving fridge + product
Your answer
Recipient Contact *
Point of contact who will be handling all coordination from recipient side
Your answer
Recipient Email *
Your answer
Recipient Phone *
Your answer
Recipient Address *
Your answer
Product Requested *
Case #, Flavor, Frequency (E.g. 3 Cases, Pomegranate, Every 2 weeks)
Your answer
Fridge Placement Requested *
If YES, what type of fridge?
Your answer
Start Date of Program *
MM
/
DD
/
YYYY
End Date of Program *
MM
/
DD
/
YYYY
Submit
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