The Co-op Food Stores of New Hampshire and Vermont

Product Request Form

Got a product you’d love to see us carry in our stores? Let us know by filling out the form below.

Name: *

Email Address: *

Address: *

Phone: *

Member Number (If Applicable):

Date: *

Product Name/Type: *

Will this product be new to the Co-op?: *

Yes

Don't Know

If there is a similar product on the shelf, how does this product differ?: *

How did you become aware of this product?: *

Internet

Word of Mouth

Prior Purchase

Direct from Manufacturer

Other Retailer

Other

How often and in what quantity do you expect you will purchase this product?: *

Additional info that may help in sourcing (brand, upc, etc).: *

In what way(s) does this product meet the Co-op End Statements?: *

Grown and/or Produced Locally

Healthy

Sustainable

Fair Trade

Cooperative

Affordable

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The Hanover Consumer Cooperative Society, Inc.