Legal Business Name
Trading Name (DBA)
Company Registration Number
Date of Incorporation
Website URL
Legal Business Name
Manufacturer
Distributor/Wholesaler
Service Provider
Consultant
Contact Type | Name | Title | Email Address | Phone Number | |
|---|---|---|---|---|---|
Primary/Sales | |||||
Accounts Receivable | |||||
Legal/Contractual | |||||
Emergency/After Hours |
Street Address
City
State/Province
Postal/Zip Code
Country
Street Address
City
State/Province
Postal/Zip Code
Country
Tax Identification Number (TIN/VAT/GST)
Preferred Payment Currency
Payment Terms (Standard is Net 30)
Bank Name
BIC Code
IBAN/Account Number
Quality Certifications (e.g., ISO 9001)
Does your company have a Code of Conduct?
Insurance Coverage
Type of insurance coverage | Yes/No | Limit | |
|---|---|---|---|
General Liability | |||
Professional Indemnity | |||
Worker's Compensation |
Core Products/Services Offered:
Trade References (List two):
Company Name | Contact | |
|---|---|---|
I hereby certify that the information provided above is true and accurate to the best of my knowledge.
I authorize the organization to verify these details as part of the supplier qualification process.
Authorized Signature
Form Template Insights
Please remove this form template insights section before publishing.
This section establishes the formal identity of the business.
A robust form separates contacts by function rather than just asking for a general email.
This is the most critical part of the data collection for ensuring accurate transactions.
This part of the form acts as a filter for professional standards and operational readiness.
References provide a window into the actual experience of working with the business.
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation before publishing.
Without the following five categories, a supplier cannot be safely or legally onboarded into a professional system.