Prospective Suppliers Application Form "*" indicates required fields * indicates required fields. If required field is not applicable, enter N/A.General informationLegal business or individual name*DBA Name (if applicable)Billing Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Website DUNsFederal Tax IDDate Established*Parent Company Name (if applicable)Owned by Foreign Entity?* Yes No Is the company a Diverse Business Enterprise? Check any that apply. Women-Owned Minority-Owned Veteran-Owned Service Disabled Veteran-Owned LGBTQ-Owned Disable-Owned HUBZone Business Small Disadvantage Business Small Business Administration 8(a) Business Aboriginal First Nations Business Minority Owned (African American / Black, Hispanic, Native American, Asian American, Asian-Pacific-Islander Business Union Workforce?* Yes No Number of Employees*What experience does the company have working with heavy equipment manufacturers?*What major industries do you serve?*Primary commodities, products, or services offered.*Major manufacturers and brands represented.*What engineering and technical support does your company have for customers?*What engineering software does your company utilize?*Standard Payment Terms:*Standard Delivery Terms:Shipping/Receiving Hours:Has your company been involved in bankruptcy proceedings over the last 3 years?* Yes No Does your company have any previous or ongoing legal proceedings to disclose?* Yes No Contact InformationCustomer Service/Sales Contact Name:* First Last Customer Service/Sales Contact Email:* Customer Service/Sales Contact Phone:*Accounts Receivables Contact Name: First Last Accounts Receivables Contact Email: Accounts Receivables Contact Phone:Quality/Technical Support Contact Name: First Last Quality/Technical Support Contact Email: Quality/Technical Support Contact Phone:Engineering Contact Name: First Last Engineering Contact Email: Engineering Contact Phone:If there is any other important information, please include it here:NameThis field is for validation purposes and should be left unchanged. Δ
