subject_line

Prospective Supplier Request

Supplier name *

Office Phone Number * 🛈

Street Address *

Street Address 2

City *

State/Province/Region *

Zip/Postal Code *

Country *

Website URL

DUNS number 🛈

Federal Tax ID #

Attach your W9 form here

Description of Products &/or Services Provided: *

Commodity Identification *

How many years has your company been in business? *

Sales Member Contact Information

First Name *

Last Name *

Title *

Phone Number * 🛈

Email Address *

Accounts Receivable Contact Information

First Name 🛈

Last Name

Title

Phone Number 🛈

Email Address

Questionnaire

Do you currently use the Coupa Supplier Portal to submit invoices for payment? *

Yes

If you do not currently have an account, are you willing to create a Coupa Supplier Portal account for the purpose of doing business with LLS? *

Yes

If you are not able to use the Coupa Supplier Portal, please explain why? *

Is your company Diversity Certified? *

Yes

If yes attach Diversity Certificate(s): *

Which of the below categories describe your company? *

Small Business	Woman Owned Business
Veteran Owned Business	Service Disabled Veteran Owned Business
Minority Owned Business	African American
Alaskan Native/Indian Tribe	Alaskan Native/ Indian Tribe (not certified by SBA as SDB)
Native American	Asian Pacific American
Hispanic American	Subcontinent Asian
Small Disadvantage Business (SDB)	Small Disadvantage (8a)
HUBZone Certified	Gay Lesbians' Bisexual Transgender
Protected Workshop (Disabled)	Green Certified
Foreign Business	Others Others

Does your company currently operate under any of the following Sustainability Policies?

Biodegradable

Corporate Social responsibility

Energy Conservation Management

Environmental Policy

Health & Safety Management

Quality Management Policy

Renewable/Recycled Products (FSC Certified Products)

Waste management Policy

Other Other

Why do you think you will be a good business partner to LLS?