Enviando solicitud

REGISTRO INTERNO
DE PROVEEDORES

1 COMPANY NAME: ( required )

1.1 FORMER NAME:

2 TYPE OF BUSINESS: ( required ) Manufacturer, Distributor, Authorized Distributor, Services, Trader, Other (if Other please indicate)

3 PRODUCT LINES:

4 BRANDS:

5 ADDRESS: ( required )

6 CITY, STATE, ZIP: ( required )

7 COUNTRY: ( required )

8 TELEPHONE NUMBER: ( required )

9 FAX NUMBER:

10 WEBSITE: ( required )

11 EMAIL-1: ( required )

12 EMAIL-2:

13 CONTACT PERSON: ( required )

13.1 DIRECT TELEPHONE NUMBER: ( required )

14 REGISTRATION REQUESTED BY: ( required )

15 DUN & BRADSRTREET NUMBER: