Distributor Co-Op Request for Media/Promo

Company Name*
Name*
First Last
Email*
For What Type of Marketing Are You Requesting Reimbursement?*
- Print Advertisment
- Digital Advertisement
- Printed Literature/Catalogs
- Promotional Item/Swag
- Tradeshow
- Video/Photography
Date Print Advertisement was Published*
MM slash DD slash YYYY
Upload Photo of Final Print Advertisement*
Max. file size: 63 MB.
First Date Digital Advertisement was Published*
MM slash DD slash YYYY
Upload Photo of Final Digital Advertisement*
Max. file size: 63 MB.
Date Literature was Printed*
MM slash DD slash YYYY
Upload Copy of Final Flyer*
Max. file size: 63 MB.
Date Promotional Items Were Purchased*
MM slash DD slash YYYY
Upload Photo of Final Product*
Max. file size: 63 MB.
Date of Tradeshow*
MM slash DD slash YYYY
Upload Photo of Tradeshow Booth*
Max. file size: 63 MB.
First Date Photography/Video was Promoted*
MM slash DD slash YYYY
Add Link to Photography or Video*
Was Fire-Dex the Only Company Listed/Visible?*
- Yes
- No
Upload Proof of Original Payment*
Max. file size: 63 MB.
Upload Invoice to Fire-Dex*
Max. file size: 63 MB.

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