Supplier Registration

Section I. Business Section

Legal Company Name

DBA Company Name(optional)

Federal Tax ID

D&B DUNS Number(optional)

Physical Address

Please enter the location of the corporate office

Address 1

Address 2(optional)

City

State

Zip/ Postal Code

Phone

( )

EXT

Contact Information

Company Phone Number

( )

EXT

Company Fax Number

( )

EXT

Company Website (URL)

Contact Name

Title

Phone Number

( )

EXT

Fax Number

( )

EXT

Email

Principal Owner Information

Owner 1

Name

Title

Email

Gender

Owner Ethnicity

% Ownership

Add another owner

Section II. Business Biography

Company Data

Business Type

Legal Structure

Geographical Service Areas

Year Established

Number of Employees

Select Ferguson Categories

Select Primary NAICS Code

View options to select NAICS code

Remove

Select Secondary NAICS Code

View options to select NAICS code

Remove

Describe the Product Lines / Services your company provides using keywords

Annual Sales For 2022

Annual Sales For 2021

Annual Sales For 2020

References

Reference 1

Company Name

Contact Name

Phone Number

( )

EXT

Email

Reference 2

Company Name

Contact Name

Phone Number

( )

EXT

Email

Reference 3

Company Name:

Contact Name:

Phone Number:

( )

EXT

Email:

Section III. Business Classifications

Certification Information

If your company is certified as SMWSDV/V, please list the certifying agency, and upload a copy of your certification. Attachments must be 4 MB or less.

Certifying Agency

Small
Business
Enterprise

Minority Business Enterprise

Woman Business Enterprise

Service Disable/Veteran Business Enterprise

Section IV. E-Business Readiness

Can the company sell products/services online?

Yes No

Does the company have Electronic Data Interchange (EDI) or XML(Extensible Mark-up Language) capabilities?

Yes No

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Attachments must be 4 MB or less

Preparer's Name

Preparer's Phone Number

( )

EXT

Preparer's Email Address

Supplier Registration Form

Section I. Business Section

Physical Address

Mailing Address

Contact Information

Principal Owner Information

Owner 1

Owner 2

Owner 3

Section II. Business Biography

Company Data

Select Ferguson Categories

References

Reference 1

Reference 2

Reference 3

Section III. Business Classifications

Certification Information

Certifying Agency

Section IV. E-Business Readiness

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