AGREEMENT
NORTH DAKOTA GROCERS ASSOCIATION COUPON REDEMPTION CENTER

  1. I [We] hereby request that the North Dakota Grocers Association act as my [our] agent in collecting money due me for any and all coupons I submit to the association for redemption. Redemption is defined as stated in Section 8 of contractual agreement, between International Outsourcing Services and the North Dakota Grocers Association. I certify to you that all coupons submitted to you herewith, or in the future, have been or will be redeemed by us strictly in accordance with the written provisions on the face of each coupon so submitted.
  2. I [We] understand that coupons submitted to NDGA need to be separated (pads of coupons not separated may be rejected by coupon processors). Coupon Totals are recommended and will be used by NDGA to work with third party processors to assure adequate coupon reimbursement. Such requests will result in assessment of an annual processing fee, which will be assessed against retailer and/or processor.
  3. I understand that I will receive an advance payment upon receiving the coupon valuation from the processor. The redemption center may retain a portion of coupon shipment if there’s a problem with expired coupons or chargebacks.
  4. I further agree that all coupons submitted remain my property until redeemed and to hold the association and its officers harmless from any and all claims or judgments resulting from failure on my part to redeem coupons in accordance with the requirements of the manufacturer issuing the same, including attorney’s fees and court costs.
  5. I AM REQUIRED TO NOTIFY THE NORTH DAKOTA GROCERS UPON SALE OR TERMINATION OF MY BUSINESS. This can be done with a letter in the bag or box of your last shipment of coupons.
AUTHORIZATION FOR COUPON DIRECT PAYMENTS (ACH CREDITS)

The coupon customer below authorizes North Dakota Grocers Association (NDGA) to issue ACH credits to their bank account for the coupons redeemed at the customer’s location. NDGA is also authorized to initiate adjustments for any transactions credited/debited in error.

Each ACH entry that a Customer initiates pursuant to this Authorization shall be subject to the terms of this Authorization and the Operating Rules of the National Automated Clearing House Association, as amended from time to time. This authorization shall remain in full force and effect until NDGA has received written notification from the CUSTOMER of its termination and NDGA and the depository shall have had a reasonable opportunity to act on the termination

NDGA: PAM TOWNE
PO BOX 96
MOFFIT, ND 58560
PHONE #: 701.223.4106
EMAIL: PNDGA@BEKTEL.COM
SPARTAN NASH
850 76TH ST SW
GR761204
BYRON CENTER, MI 49315
PHONE #: 616.878.8977
RETAILERS REDEEMING MANUFACTURER COUPONS -- STANDARD QUESTIONNAIRE

The purpose of this questionnaire is to provide coupon issuing manufactures with data on retailers who redeem coupons. All information submitted will be held strictly confidential. This coupon questionnaire must be completed and in file before payment can be issued for coupon submission. Return completed questionnaire to: NORTH DAKOTA GROCERS ASSOCIATION.

A separate questionnaire is to be prepared by each entity submitting coupons for redemption (i.e. individual store division or company, as appropriate).

(if different from physical address)
(List of addresses and telephone numbers for more than one store)
(if applicable)
(FEDERAL TAX ID #)
(if applicable)
(primary)
(Secondary)
Store Data
Number of Stores
Average selling square foot per store
Average checkouts per store
Average weekly open hours
Food Store(s)
Conventional Supermarket
Combination
Warehouse
Small Store
Specialty
Convenience
Drug Store(s)
Pharmacy
Full Line
Liquor Store


































Coupon Data (for total entity submitting coupons - store, company, division)

(provide name(s) and address(es))
NAME: ND GROCERS ASSOCIATION
ADDRESS: PO BOX 96
CITY: MOFFIT STATE: ND ZIP CODE: 58560
(i.e. doubling or tripling coupons?)
I hereby certify that all information provided in this questionnaire is correct