Supplier Information Form

Company information

Company name:

Street:

PO Box:

City:  

State:  Zip:  

Country, if outside US:

Phone number:

Email:

Fax:

Web Site:

Business information

Annual sales $ for the year

Service area:
Local Regional National International

Service area
(Explain main warehouse locations, service reps, etc.)

Year company was established:

Parent company:

Incorporated Publicly held Privately held
Incorporated state

Total number of employees

Principle products/services/manufacturers:

Certification information

If you are a contractor, do you have a North Dakota Contractor's License?yes no
If so, number:  
Contractors are required to provide proof of Worker's Compensation Insurance and current Certificate of Insurance upon award of a contract and before performing the work.

Major customer/references

1) Customer:  
Contact:  Phone:

2) Customer:
Contact:  Phone:

 3) Customer:
Contact:  Phone:

Comments:

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