Distributor Alliance Program Registration

** FERGUSON ENTERPRISES, INC. WILL TREAT ALL INFORMATION AND DOCUMENTATION PROVIDED IN RESPONSE TO THIS APPLICATION AS CONFIDENTIAL INFORMATION OF THE APPLICANT. NO INFORMATION WILL BE DISCLOSED TO ANY THIRD PARTY, UNLESS REQUIRED BY LAW OR GOVERNMENTAL ACTION.COMPLETING AND SUBMITTING THE DISTRIBUTOR ALLIANCE PROGRAM APPLICATION DOES NOT GUARANTEE ACCEPTANCE INTO THE PROGRAM.

Instructions: Please complete all questions and provide supporting documentation where requested. Incomplete responses will delay consideration of your company’s application. Email the completed questionnaire and supporting documentation to: dap@ferguson.com

Thank you.

* Required fields are denoted without an "Optional" label.

SECTION I – BUSINESS CONTACT INFORMATION

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Principle Owner Information:

SECTION II – BUSINESS BACKGROUND INFORMATION

Business References:

Reference 1

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Reference 2

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Reference 3

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SECTION III – BUSINESS PROFILE

Business Responses
1

Business entity is certified as one or more of the following classifications (check all that apply):

Disadvantaged Business Enterprise (DBE)
Minority Business Enterprise (MBE)
Veteran or Service Disable Veteran-owned Business Enterprise (VSDVBE)
Women-owned Business Enterprise (WBE)
Small Business Enterprise (SBE)
Local Business Enterprise (LBE)
Federal (HUBzone, 8 (a), WOSB)
National Minority Supplier Development Council (NMSDC)
Women's Business Enterprise National Council (WBENC)

** Please attach all current state and local certifications and the certification(s) of NAICS classifications that the business entity is approved to supply.

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2

Is the business entity certified under state or local governments to sell other products (e.g. office supplies, construction equipment, building materials, electrical supplies, etc.)? Please answer: YES or NO.

YES
NO
3

Does the business entity have industry experience and knowledge in the respective NACIS codes listed (e.g., Plumbing, PVF, Facilities Maintenance, MRO, Janitorial/Sanitation Supplies, WW, HVAC, etc.) to provide technical assistance to the purchaser before, during, and after the sale and installation of the product(s)? Please answer YES or NO. If YES, please provide two current examples of projects under your respective NAICS codes.

YES
NO
4

Will your company be exporting products purchased from Ferguson for Federal government projects(DoD, DLA etc)? Please answer: YES or NO. If YES, please provide detailed information.

YES
NO
5

Does the business entity assume credit risk for your customers (pays for materials, then bills customer)? Please answer: YES or NO. If YES, please provide detailed information.

YES
NO
6

Does the business entity have a business account in place to receive payments directly in the name of the business entity? Please answer: YES or NO. If YES, Please provide detailed information.

YES
NO
7

Does the business entity have an e-commerce platform in place? Please answer: YES or NO. If YES, please provide detailed information.

YES
NO
8

Does the business entity have capabilities to conduct business via EDI or XML? Please answer: YES or NO. If YES, please provide detailed information.

YES
NO
9

Does the business entity visit the job site for a genuine purpose to benefit the project? Please answer: YES or NO. If YES, please provide detailed information.

YES
NO

Certification

The undersigned hereby verifies that all information and statements submitted herein, including any supporting documents, are true and correct to the best of his/her knowledge and all responses to the questions are full and complete, omitting no material information. I understand and acknowledge that Ferguson Enterprises, Inc. relies upon the accuracy and completeness of this information to establish eligibility for the Distribution Alliance Program (“Program”) and that any misrepresentation or misstatement of fact may be grounds for immediate disqualification from the Program. I agree to provide Ferguson written notice of any material change in the information contained in this registration, including without limitation any change in ownership, contact information, and status of certification.