Supplier Setup Request Form
Instructions/Purpose: This form is used to setup a new supplier or change information for an existing
supplier. The completed form and a copy of the W-9 or W-8 must be forwarded to Purchasing via email to
[email protected] or faxed to 920-766-8711.
Supplier Information: (check facilities this applies to):
Kaukauna
DePere
Mosinee
Old Town
Rhinelander
Federal ID or Tax ID #: (REQUIRED)
Supplier Name (Order to):
Supplier Address:
City:
Supplier Email Address:
State:
Supplier Phone Number:
Province:
Supplier Fax Number:
County:
Zip:
Contact Name:
Off-Hours Contact Name with Phone Number: (provide 2 if possible)
1)
2)
Preferred method of receiving Purchase Orders:
Fax or
Fax # :
Email Address:
Country:
Contact Phone Number:
Email Please check a box
Banking Information (fill out Bank information, if you want to be paid by ACH) PREFERRED
Bank Name:
Routing #:
Banking #:
Bank Address:
Organization Type: (you MUST choose one of the following):
Individual
Government Agency
Partnership/LLP/LLC
Non Profit
Corporation
Foreign Government Agency
Foreign Corporation/Partnership
Foreign Individual
Supplier Name:
Remittance
Telephone Number:
address if different
Fax Number:
from above:
Minority Status:
Minority
Certified
Not Certified
Women-Owned
Asian-Pacific
Veteran
Disabled/Other
Hispanic
Asian-Indian
African American
Certificate must be attached
Supplier Address:
Email Address for ACH Remittance:
Internal Use Only
CDC Vendor
Yes
Outsource Vendor
No
Yes
Fiber Certification ___________________
No
Name of Person Submitting Request:
If yes, initiate Outsource Procedure Agreement
Request Date
Reason for Request (if applicable): ____Add New Supplier ____Update Existing Supplier (give reason why)
____ Check Request
Supplier Terms (Required):
Payment Terms:
Freight Code:
NET 45 DAYS
Approved By:
Date:
Vendor Number Assigned:
Raw Material Supplier Requirements sent
Non-Disclosure Agreement signed with Supplier
Certificate of Insurance on file for Supplier
Updated MSDS forms on file for Supplier
M:\Sourcing\Forms\Expera Forms\Expera Supplier Setup Request Form.doc