New Brand Application Share Your Wellness Products With the Rest of Canada "*" indicates required fields 1Product Information2Current Customer Base3Contact Info Product Name* Product Website Product Categories (Health & Beauty, Snacks, Groceries, Drinks, etc)Please upload your sell sheet or product imageMax. file size: 10 MB.Where is your product manufactured?* Canada US Other Where would you like us to distribute your products?* BC SK ON NB PE AB MB QC NS NL Do you have a Canadian broker?* Yes No Who is your broker? Do you have current retailer customers?* Yes No List Retailers*In Canadian dollars, what is the approximate current annual retail sales for this product?* <$100K $101K - $300K $301K- $500K $501K - $1MM >$1MM Where are your current retailer customers located?* BC AB SK MB ON QC NB PE NL US Other Will you be transitioning any of these retailer accounts to Headwater Sales & Imports?* Yes No Unsure at this time First Name Last Name Cell PhoneBusiness Name Head Office Warehouse Locations Email* Website Is there any other relevant information you would like to share?
