Sales Inquiry Are your receiving locations outside of the US? Yes No * Company Name: * Contact Name: * Contact Email: Company Address * Address: Address 2: * City: * State: Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Virgin Islands Guam Pacific Northwest * Zip Code: * Country: * Company Phone: Receiving Location Address Address: Address 2: City: State: Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Virgin Islands Guam Pacific Northwest Zip Code: Country: Are you a commercial account such as janitorial service, manufacturer, hotel, etc? Yes No Do you currently purchase Church & Dwight products through a 3rd party? Yes No If yes, please provide the 3rd party: Are you EDI capable? Yes No Please indicate which types of products you are interested in: Household (Liquid laundry, household cleaners, cat litter, etc.) - Will you be meeting the 10,000 lb minimum per order? Yes No Personal Care (Toothpaste, deodorant, condoms, etc.) - Will you be meeting the $2,000 minimum per order? Yes No Vitamins (Lil Critters, Vitafusion, Nutrition Now, Probiotics) - Will you be meeting the $4,000 minimum per order? Yes No Do you do the majority of your business online? Yes No If so, please provide the name of the website: I have read and accept the Privacy Policy and Terms & Conditions * I Agree You agree that information submitted on this form may be shared internally with Church & Dwight and you agree that Church & Dwight may contact you regarding this submission. Submit Please agree to the Terms and Conditions to submit the form.