Supplier Setup Form
ALL FIELDS ARE MANDATORY – IF INCOMPLETE VENDOR WILL BE REJECTED
General Information
Supplier Name
Check Name (If Different from Above)
Business Classification
Class ID
Federal Tax ID (If none, SSN)
HFM Code (If Emerson Business Unit)
Payment Terms (Standard 5th 3rd Prox)
FOB Point
Hours of Operation (Include Time Zone)
W9 Form Domestic (Required)
CLICK HERE TO DOWNLOAD W9
W8 Form Foreign Service ONLY
CLICK HERE TO DOWNLOAD W8
(Required)
Physical Address (No PO Boxes)
Street Address
City/Township
State/Providence
Postal Code
Country
Country Code
Remit To Address
Street Address
City/Township
State/Providence
Postal Code
Country
Country Code
Approvals
Revision
Originator/Date
Reviewed/Date
Page 1 of 3
R4
AJC 6/10/2013
PS 6/10/2013
R5
AJC 5/23/2014
PS 5/23/2014
R6
AJC 6/4/2014
PS 6/4/2014
R7
AJC 3/31/2015
PS 3/31/2015
R8
AJC 6/4/2016
PS 6/4/2016
FRM-SSF R8
Primary Contact Information
Name
Title
Phone Number
Fax Number
Email Address
Primary Backup Contact Information
Name
Title
Phone Number
Email Address
Supervisor of Primary Contact Information
Name
Title
Phone Number
Email Address
Plant Manager, Owner or CEO Contact
Name
Title
Phone Number
Email Address
Accounting Contact Information
Name
Title
Phone Number
Email Address
Supplier Certification Details (Provide Copies of all Certificates)
ISO/QMS Status
ISO Expiration Date (If Applicable)
10 CFR 50 Appendix B/Part 21 Program (Nuclear)
Original Nuclear Certification Date
Small Business Administration Initiative? (If Applicable)
C-TPAT Certificate? (If Applicable)
Approvals
Revision
Originator/Date
Reviewed/Date
Page 2 of 3
R4
AJC 6/10/2013
PS 6/10/2013
R5
AJC 5/23/2014
PS 5/23/2014
R6
AJC 6/4/2014
PS 6/4/2014
R7
AJC 3/31/2015
PS 3/31/2015
R8
AJC 6/4/2016
PS 6/4/2016
FRM-SSF R8
Supplier Certification Details (Continued)
Certificate of Insurance Required (COI)?
COI Effective Date
COI Expiration Date
TO BE COMPLETED BY TOPWORX
Requested by:
Request Date:
Request Type:
Inventory Parts Supplier:
If Inventory Parts Supplier, Has NDA been
received? (Must be complete before
Vendor is setup)
NDA-D & B Obtained and attached?
DRI CODE (Scope of Supply)
Supplier Score Card Frequency
Nuclear Certification Type (If Applicable)
Nuclear Audit Date
Nuclear Audit Frequency
Due Diligence Questionnaire Required?
RPL screen completed by:
TopWorx
(Include RPL confirmation request)
or
Fisher Trade Compliance
Supply Chain Manager Approval
Finance Approval
Max Vendor ID (Assigned by Finance)
FORM SHOULD REMAIN IN PDF FORMAT WHEN THE VENDOR RETURNS THE
COMPLETED FORM. Once this form is received back from the vendor, purchasing will file the
form in \\Records\Supply Chain\Supplier Setup and send a link for approvals via email.
Approvals
Revision
Originator/Date
Reviewed/Date
Page 3 of 3
R4
AJC 6/10/2013
PS 6/10/2013
R5
AJC 5/23/2014
PS 5/23/2014
R6
AJC 6/4/2014
PS 6/4/2014
R7
AJC 3/31/2015
PS 3/31/2015
R8
AJC 6/4/2016
PS 6/4/2016
FRM-SSF R8