Mercados SUVIANDA

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SV NEW SUPPLIER & MAINTENANCE FORM

Type of Supplier Request

New or Change

COMPANY INFORMATION

COMPANY NAME:
ADDRESS LINE1:
ADDRESS LINE2:
CITY/ST/ZIP:
PHONE#:
FAX#:
CONTACT PERSON:
E-MAIL OF CONTACT PERSON:
PRODUCT LIABILITY:

SV Use Only

Date Keyed:
DSD Vendor Number:
WHS Vendor Number:
Category/Procurement Mgr:
Initials of processor:

Account Payable Information(Remittance Information) DSD & Warehouse Vendors

Remittance Name:
Address:
City/ST/ZIP:
Contact Person:

Payment Method:	Wire Transfer:	Letter of Credit:
Payment Terms:		Days	Net

SV engages an outside firm to audit account payables and reserves the right to collect post audit claims for a period of four years from the date of an invoice.

Vendor Representative Information(Broker)/Buying Agent

COMPANY NAME
ADDRESS LINE1:
ADDRESS LINE2:
CITY/ST/ZIP:
PHONE# / FAX#

CONTACT PERSON:
DUNS#(if known):
TAX ID $:(Required)
E-MAIL ADDRESS:

VENDOR / BROKER SIGNATURE:
(Mandatory - Signature Mag Be Typed)
CM/PM SIGNATURE:
(Mandatory)

Date:

Date: