On-Line Retailer Sign-Up Form


Thank you for your interest in the
Kimberly-Clark On-Line Retailer Connection Program

Retailer Name: 
Contact Name: 
Contact Street: 
Contact City: 
Contact State:      Province:     
Contact Zip: 
Contact Country:  United States Canada
Contact Phone: 
Contact Fax: 
Contact Email: 
Retailer Web Site Address*:  http:// 
* An active retailer web site is required to participate in this program.
Home Delivery Available? (Must be classified as a "national account" and deliver throughout the United States to be included in this option.)


Which brands would you like to participate with?
Cottonelle®
Depend®
GoodNites®
Huggies®
Kleenex®
Kotex® 		Little Swimmers®
Poise®
Pull-Ups®
Scott®
The Neat Sheet®
Viva®


Which products do you sell, and in which countries?
 USCanada
Huggies* Disposable Changing Pads
Huggies® Baby Bath
Huggies® Convertibles®
Huggies® Overnites
Huggies® Preemies
The Neat Sheet® Ground Cover



For more information about other great Kimberly-Clark
brands, visit our Kimberly-Clark Corporation website. 

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