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RETAIL LINK INTERNET FORM VENDOR FACT SHEET PLEASE PRINT LEGIBLY COMPANY NAME as it appears on your Purchase Orders DOING BUSINESS AS if same as above, please leave blank WHO DISTRIBUTES YOUR ITEMS? We distribute our own: ______ McLanes:______ Fleming: ______ Other: NAME OF SITE ADMINISTRATOR SITE ADMINISTRATOR’S INTERNET EMAIL ADDRESS see below for more details on email address STREET ADDRESS CITY, STATE, ZIP, COUNTRY PHONE NUMBER FAX NUMBER ACCESS NEEDED WAL-MART DEPARTMENT PRODUCT DESTINATION HOST VENDOR# 6-DIGIT BUYER CONTACT From the following categories, please specif