Super Food Coffee $40 Consignment Agreement
I, _____________________________, the owner of the below business request consideration for the consignment program. I understand that 100 companies will be selected for this pilot program based on qualification and first right of refusal.

I understand, if approved based on my current and projected business, that I will receive two boxes of product plus shipping on consignment for $40.

I understand I will be given up to 15 days to market the consignment. At the end of the 15 days I must return the remaining product with any prorated wholesale value for sold product or accept the product and pay $40. (Up to $100 Suggested Retail Value when sold individual.)

This pre-agreement is dated ______________ Referral ID ____________

Name _____________________________

Company Name ______________________ Business License Number _____________

Street _________________________________ Tax ID if required _______________

City ___________________________ State _____ Zip _________

Phone _________________________

Email ________________________________________________________

Estimated cups of coffee per week ______ Please provide copy of current menu


Acknowledgement for Product Received

I, __________________________, received the below $40 consignment containing:

___ Black Coffee (1) ___ Tea (1) ___ Mocha (0)
___ Tongkat Ali (0) ___ 3 in 1 (0) ___ Hot Chocolate (0)

on _____________. Initials _______


Signature for Disposition of Product

 
Signatures
I returned / purchased the consignment on _________. Merchant:          ________________
  Representative: ________________