Company Name
*
DBA, Trade Name, Abbreviation
Submitting Vendor's EIN/SSN/TIN
*
Type of Company
*
Please include core competencies, equipment, size, products, services, certificates, and licensure.
Company Contact
*
First Name
Last Name
Contact Title
Contact Direct Phone/Cell
*
(###)
###
####
Contact Email
*
Primary Place of Business Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Primary Business Phone Number
*
(###)
###
####
Main Business Email
Primary Business Fax Number
(###)
###
####
Secondary Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Secondary Address Type
Company Facilities
Owned
Leased
Unknown
Business Entity Type
Company Annual Gross Revenue (USD)
0-49, 999
50,000 - 99,999
100,000 - 499,999
500,000 - 999,999
1,000,000 - 2,499,999
2,500,000 - 4,999,999
5,000,000 - 19,999,999
20,000,000 - 39,999,999
40,000,000 - 69,999,999
70,000,000 - 99,999,999
100,000,000 or more
DUNS Number
National or regional stock exchange or NASDAQ listing, if applicable
Does your company now use, or has used in the past 10 years, an EIN, TIN, SSN, DBA, trade name, abbreviation other than the company name provided above? If so, please provide all such names and numbers below:
Do you share office space, staff, equipment or expenses with any other entities?
Unknown
No
Yes
Do you anticipate occupying any additional or alternative addresses in the next three years other than those listed above?
Unknown
No
Yes, business may acquire additional space
Yes, business may relocate
Is more than 10 percent of the company's stock or ownership currently used or pledged as collateral for any loan or obligation?
Unknown
No
Yes
Does your company control one or more entities or have one or more affiliates and/or is it a subsidiary of and controlled by another entity?
Unknown
No
Yes, has affiliates
Yes, is a subsidiary or otherwise controlled
Have any bankruptcy proceedings been initiated by or against your company or its affiliates within the past seven (7) years (whether or not closed) or is any such proceeding pending?
Unknown
No
Yes
Does your company have any established quality control program?
Unknown
No
Yes, informal
Yes, formal
Yes, formal with dedicated QC staff
I certify that the answers given here are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this vendor partnership application as may be necessary in arriving at a decision to begin working with Attract. In the event of a business relationship, I understand that false or misleading information given in this submission may result in the necessity to dissolve our relationship.
