Supplier Information
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| Business Name:
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Federal Tax ID:
Must have a Federal Tax ID in order to register
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Type of Supplier
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Large Business Concern
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Small Business Concern
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Non-Profit Organization
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Type of Business
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Broker
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Contractor
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Distributor
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Manufacturer
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Retailer
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Other:
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Website Address
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Yes, I prefer to do business and ordering through my company website.
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No, I prefer to do business and ordering via email that is provided below.
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Address Information
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Business Address
Line 1
Line 2
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Mailing Address
Line 1
Line 2
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City:
State:
Zip:
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City:
State:
Zip:
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Contact Information
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Primary Contact Name and Information
Name/Title
E-Mail
Telephone
Fax Number
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Secondary Contact Name and Information
Name/Title
E-Mail
Telephone
Fax Number
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Additional Contact Information
Checkbox Goes Here
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Sales Representative 1
Name/Title
E-Mail
Telephone
Fax Number
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Sales Representative 2
Name/Title
E-Mail
Telephone
Fax Number
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Customer Servce
Name/Title
E-Mail
Telephone
Fax Number
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Commodity Listing
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Shipping Terms
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Shipping terms are considered FOB, Net 30, unless otherwise identified and negotiated.
If different, please state here:
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General Information
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Please state the name of the East Central College employee(s) with whom you've been speaking:
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Vendor Registration Community Listing
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NOTE: The Supplier Information Form and the Vendor Registration Commodity Listing must be completed to be included on the
East Central College Official Bid and Vendor listings.
It is the responsibility of the Vendor to see that the information provided is current and accurate. All updates are the sole
responsibility of the Vendor and should be made through the Vendor Registration site.
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