Non-Beverage Questionnaire - Northeast Independent Distributors Association

Please complete and submit the following questionnaire in full.

After the information is reviewed and accepted by the NIDA Presentation Committee, you will be contacted to coordinate a date and time where you will be asked to make a presentation to the NIDA Membership at one of our regularly scheduled meetings.

If the Brand is accepted for presentation, you will be required to remit a $2,000.00 presentation fee. Please remit payments to:

NIDA c/o Dana Distributors
ATTN: Patrick English
52 Hatfield Lane
Goshen, NY, 10924

Payment is due in full prior to the presentation date.

Step 1 of 2

Contact Information
Distributor Sponsor(s)*

Distributor Sponsor is required in order to present to NIDA
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact*
First Last
Email*
Phone #*

*Please be advised that by presenting to NIDA and paying the presentation fee in no way constitutes a relationship between the parties. There is no obligation by any member of NIDA to enter into a business relationship with supplier. Supplier agrees to indemnify and hold harmless NIDA and its individual members from any legal action resulting from presenting to NIDA and its members.*

Step 1 of 2

Contact Information

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