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Supplier Information Form

Vendor Registration

Supplier Information

Business Name: Federal Tax ID:

Must have a Federal Tax ID in order to register

Type of Supplier

Large Business Concern

Small Business Concern Non-Profit Organization

Type of Business

Broker Contractor Distributor
Manufacturer Retailer Other:

Website Address

Yes, I prefer to do business and ordering through my company website.
No, I prefer to do business and ordering via email that is provided below.

Address Information

Business Address



Line 1



Line 2

  Mailing Address



Line 1



Line 2
City:

State:

Zip:
  City:

State:

Zip:

Contact Information

Primary Contact Name and Information



Name/Title



E-Mail



Telephone



Fax Number
  Secondary Contact Name and Information

Name/Title



E-Mail



Telephone



Fax Number

Additional Contact Information

Checkbox Goes Here
Sales Representative 1



Name/Title



E-Mail



Telephone



Fax Number
  Sales Representative 2



Name/Title



E-Mail



Telephone



Fax Number
 
Customer Servce



Name/Title



E-Mail



Telephone



Fax Number

Commodity Listing

Shipping Terms

Shipping terms are considered FOB, Net 30, unless otherwise identified and negotiated.

If different, please state here:

General Information

Please state the name of the East Central College employee(s) with whom you've been speaking:

Vendor Registration Community Listing

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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