The NMC Group Supplier Application
V3: Updated January 27, 2016
Please complete this NMC Group supplier application form. All fields noted with an asterisk must
contain requested information. If application is not completely filled out; it will not be processed. You
are also required to submit a signed W-9, in accordance with IRS Rules.
Email completed form and signed W-9 to: [email protected]
This PDF form is four pages.
Prepared By *
Email *
Phone Number *
Name of Organization *
Legal Name of Organization *
Physical Address (street) P.O. Boxes will not be accepted.*
Address Line 2
City*
State/Province/Region*
Zip Code/Postal*
Country*
Website Address *
Minority Owned Business? *
Certified MBE? *
Yes
Yes
No
No
NMC, Inc 11002 Sapp Brothers Drive Omaha, NE 68138 The NMC Group Supplier Application V3: Updated January 18, 2016
Sales Rep Contact
Sales Rep Phone Number
Sales Rep Email
Accounts Receivable Contact
Accounts Receivable Phone Number
Accounts Receivable Email
Payment Terms*
(Recommended: 2/10, n30 or NET45)
How are orders placed? *
What is your exchange/return policy? *
What is the lead time? *
Freight Policy *
ISO Compliant?
Yes
Quality Controls?
No
Yes
No
How are Design Changes or Discontinued Products Communicated?
Dun & Bradstreet Number
Bank Name
Please advise bank information if you prefer to be paid by ACH
Street Address
NMC, Inc 11002 Sapp Brothers Drive Omaha, NE 68138 The NMC Group Supplier Application V3: Updated January 18, 2016
Address Line 2
City
State/Province/Region
Zip Code/Postal
Country
Account Type
Checking
Savings
Account Number
ABA Transit Routing Number
Ability to Trace Products Back to their Origin? *
Yes
No
How does your organization take Responsibility for Cost of Defective or Poor Performance at Customers
Location?*
Who are your competitors in the market?*
List the products and services you offer. *
List the benefits of working with your organization. *
NMC, Inc 11002 Sapp Brothers Drive Omaha, NE 68138 The NMC Group Supplier Application V3: Updated January 18, 2016
Name *
Initials *
Phone Number *
Email *
Date *
By electronically signing this document, you are certifying that you are authorized to submit
this application on behalf of the Supplier, the information is accurate and complete and that
you are submitting this document and accepting the terms contained in it on behalf of the
Supplier.
To electronically sign this document, please check this box.
Please email this completed application with a signed W-9 PDF accordance with IRS rules to:
[email protected]
NMC, Inc 11002 Sapp Brothers Drive Omaha, NE 68138 The NMC Group Supplier Application V3: Updated January 18, 2016