YOUR INFORMATION

First Name 

Last Name

Cell Phone

Email

STORE SPECIFIC INFORMATION

HOW MANY LOCATIONS/SITES/STORES DO YOU HAVE?

Please select... 1 2-4 5-9 10-19 20-49 50-99 100-199 200+

Which States do you have stores in?

Please select... Connecticut Delaware District Of Columbia Maine Maryland Massachusetts New Hampshire New Jersey New York Pennsylvania Rhode Island Vermont Virginia Other

Give us one of your store Account #s

Account / Store Name

Store Phone #

ACCRUAL PROGRAM INFORMATION

Did you participate in an NCD MAP program in any prior year through any division
(HLA, Polep, Allen Brothers, Century?)

Please select... Yes No Not Sure Other

Do you currently participate in any other distributor's accrual programs?

Please select... Yes No Not Sure Other

Tell us which Distributor(s) Programs you currently participate in...

PAST EXPERIENCE

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Worth the time and energy
Great selection of programs
The rebate opportunities were tremendous
I was pleased with the brands represented
My sales consultant helped to keep me compliant on the programs

Anything else you'd like to share on your experience?

ABOUT YOUR TERRITORY/SALES CONSULTANT

WHICH NCD DIVISION / DISTRIBUTION CENTER DO YOU WORK WITH?

Please select... CHICOPEE / NORTH / POLEP FARMINGDALE / CENTRAL / HLA PHILADELPHIA / SOUTH / ALLEN BROTHERS ROCKVILLE DC / CENTURY I DON'T KNOW

SALES REPRESENTATIVE FARMINGDALE/HLA DC

Please select... ALAN PEDERSEN ALANA RAIOLA ANDREW BUTLER ANKIT SINGH ANTHONY CATALANOTTO BEKA MSKHILADZE BRIAN LEROUX BRIAN SPARE CHRIS GLOVER CHRIS KREYE CHRISTIAN BERNABEL CHRISTINA ROBERTS CLIFF KRAMER DAVE BENDLIN DAVID KNAPP DAVID PRICE DENNIS PARMAR DIST MIDWOOD DIST WESTCHESTER DYLAN HATHAWAY EMILIO MONTANEZ FRANK CHIRICO FRANK SCRUDATO FRED MAIA GABRIELLA MINIKEL GARY FLYNN GEORGE KOSTJAL GREG ROMER GURVINDER GARY SINGH HAKAN GOKGURLER HARDIK PATEL ISLAM AHMAD JACKI AYERS JACKIE EBBITT JAKE TOWNSEND JEFF HULME JEFF LAPORTE JEFF PULVER JEREMY MAGALONG KASHIF JAMIL KEITH HUGGER KEITH MANCINE KETAN SHAH KIFAH AL-ZAYDEE KRISTIN GOODWIN KRISTINA FLEMING LOU TROILO MARK BRUNO MARK HENNESSEY MARK KAVANAUGH MARK MATHIS MARK PROFETTA MATT CIBIK MATT DUNBROOK MICHAEL AMBROSIO MICHAEL BADER MICHAEL LANGANA MICHAEL MAIO MICHAEL SCHEAR MICHELLE AMMIRATI MIDWOOD SALES MIDWOOD TOBACCO MIKE FRANCIS GRIFFIN MIKE SPANAKOS MIKE TANNENBAUM MOHAMMAD SABIR MUHAMMAD NAVAID NASIM ALI NICHOLAS CYR NICK MARCELLO NICK TRIOLO NINA WOLVIN PETER LEVINE ROBERT CICCI ROBERT KORONA ROBERT MOSTACCI SCOTT FABER SCOTT KATZ SHAKIL AHMED SHILPA MAPKAR STEVE HORN STEVE SCIBILIA TENZING LAMA TIM KINNIE TOM CONRAD TRACEY SCHAEFFER VIKRAM DANIEL YONNY MERCERA ZACHARY MINNICH ZULFIQAR MAZARI

SALES REPRESENTATIVE CHICOPEE/POLEP DC

Please select... AL CAMERON ALAN PLOTKIN APRYL MACRAE BEA MARTIN BRENDA BACON BRIAN REILLY CHRIS MANNING CHRISTIAN BEAULIEU CHRISTINE GARVEY CHUCK D'ANDREA CLAUDIO ANNECCHIARICO DAN BARRY DANIEL MILLIGAN DANNY MEDERIOS DAVE MADONNA DAVE TAYLOR DAVID LEFKOWITH DAVID SLIFKA DENNIS HALEY ED CREAMER EDDIE MEDEIROS ELIE ELBACH FRANCES NUNEZ GARY MULLANE GARY WEBSTER GENE PORCIELLO JAKE HARRINGTON JEFF BLAIR JEFF PULVER (N) JENNIFER LEIDEMER JIM PHILLIPS JOE NORMAND JOE RODRIGUES KARA PALEY-RYAN KAREN FITZPATRICK (COVERING) KEVIN ROSSMEISL LARRY LEGER LAURA CROWLEY LAURIE GREENEY LEE NICOLAS LEO DEFEO LORI HARDAKER MATT MILLER MELISSA LAROSE-NICOLAS MICHAEL WEINER MICHELE HASELTINE MICHELLE ROBERTS MIKE IVAS MIKE MOORE MIKE SKOWRONEK MIKE VINCENT NAEEM (MUHAMMAD) GHAZI NATALIE TAYLOR NATE MURRAY PATRICIO HERNANDEZ PETE POIRIER PETER SIMARD RAHUL KATOCH RANDY ALLEN RENEE MACK RICH FINESTONE RICH THERRIAN RICK THOMPSON RYAN MCCARTHY SAM POLEP SCOTT OTERO SEAN CODY STEVE BINNEY SUE SCIUTO SUE TROMPKE TIM HOOKS TIMOTHY VIEHOFF TOM MARTINI VIRAL PATEL

SALES REPRESENTATIVE PHILADELPHIA/ALLEN BROTHERS DC

Please select... BOB MILLER CHRIS BYTHROW GARY KAUTZ GARY SINGH (AB) JAKE TOWNSEND (AB) JIM NORTON JOHN LUCIANO JOHN QUISITO LOU TROILO (AB) NINA WOLVIN (AB) RAVINDER WADHWA RICHARD PHILLIPS STEVE ODONNELL

SALES REPRESENTATIVE ROCKVILLE DC/CENTURY DC

Please select... LARRY ABRAMS SCOTT BONDROFF SHAUN BRETT CHRISTOPHER BURCH VERONIQUE CABULONG RUW DALUWATTE HIMASH FERNANDO ELIJAH FIGUEROA SCOTT GREENBERG GORAN HUSSEIN STACEY ISAACS KIM LAM SAM LEE SHAWN MEAD YUNG PICCOLO DAVE PREVO DARREN PULVIRENTI RACHEL RABIN SALLY RAUSCH MARTIN ROWLEY RANJAN SIRWARDANA JOSEPH SPOLTORE BILL STAMOS MARTI STEPNER ERIK SULLIVAN JESSE THERWANGER RON WINSON LORI RODMAN

Questions? Email HLA here

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