Supplier Setup Form

Supplier Setup Form
ALL FIELDS ARE MANDATORY – IF INCOMPLETE VENDOR WILL BE REJECTED
General Information
Supplier Name
Check Name (If Different from Above)
Business Classification
Class ID
Federal Tax ID (If none, SSN)
HFM Code (If Emerson Business Unit)
Payment Terms (Standard 5 th 3 rd Prox)
FOB Point
Hours of Operation (Include Time Zone)
W9 Form Domestic (Required)
CLICK HERE TO DOWNLOAD W9
W8 Form Foreign Service ONLY
CLICK HERE TO DOWNLOAD W8
(Required)
Street Address
City/Township
State/Providence
Postal Code
Country
Country Code
Street Address
City/Township
State/Providence
Postal Code
Country
Country Code
Physical Address (No PO Boxes)
Remit To Address
Approvals
Revision R3 R4 R5 R6 R7
Originator/Date AJC 1/25/2013 AJC 6/10/2013 AJC 5/23/2014 AJC 6/4/2014 AJC 3/31/2015
Reviewed/Date PS 1/28/2013 PS 6/10/2013 PS 5/23/2014 PS 6/4/2014 PS 3/31/2015
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Name
Title
Phone Number
Fax Number
Email Address
Name
Title
Phone Number
Email Address
Primary Contact Information
Primary Backup Contact Information
Accounting Contact Information
Name
Title
Phone Number
Email Address
Supervisor of Primary Contact Information
Name
Title
Phone Number
Email Address
Plant Manager, Owner or CEO Contact Information
Name
Title
Phone Number
Email Address
Supplier Certification Details (Provide Copies of all Certificates)
ISO/QMS Status
ISO Expiration Date (If Applicable)
10 CFR 50 Appendix B/Part 21 Program (Nuclear)
Original Nuclear Certification Date
Small Business Administration Initiative? (If Applicable)
NAFTA Certificate? (If Applicable)
C-TAPT Certificate? (If Applicable)
Approvals
Revision R3 R4 R5 R6 R7
Originator/Date AJC 1/25/2013 AJC 6/10/2013 AJC 5/23/2014 AJC 6/4/2014 AJC 3/31/2015
Reviewed/Date PS 1/28/2013 PS 6/10/2013 PS 5/23/2014 PS 6/4/2014 PS 3/31/2015
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TO BE COMPLETED BY TOPWORX
Requested by:
Request Date:
Request Type:
Inventory Parts Supplier:
If Inventory Parts Supplier, Has NDA been
received? (Must be complete before
Vendor is setup)
NDA-D & B Obtained and attached?
DRI CODE (Scope of Supply)
Supplier Score Card Frequency
Nuclear Certification Type (If Applicable)
Nuclear Audit Date
Nuclear Audit Frequency
Due Diligence Questionnaire Required?
RPL screen completed by:
(Include RPL confirmation request)
Supply Chain Manager Approval
TopWorx
or
Fisher Trade Compliance
Finance Approval
Max Vendor ID (Assigned by Finance)
FORM SHOULD REMAIN IN PDF FORMAT WHEN THE VENDOR RETURNS THE
COMPLETED FORM.
Once this form is received back from the vendor, purchasing will file the form in \\Records\Supply
Chain\Supplier Setup and send a link for approvals via email.
Approvals
Revision R3 R4 R5 R6 R7
Originator/Date AJC 1/25/2013 AJC 6/10/2013 AJC 5/23/2014 AJC 6/4/2014 AJC 3/31/2015
Reviewed/Date PS 1/28/2013 PS 6/10/2013 PS 5/23/2014 PS 6/4/2014 PS 3/31/2015
Page 3 of 3 FRM-SSF R7