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Prospective Supplier Questionnaire


Company Address and Contact Information
Company:
Tax ID Number:
Address Line 1 : Address Line 2:
City:
State: Zip Code:
Phone:
Ex. xxx-xxx-xxxx 		Fax:
Contact First Name:
Contact Last Name:
Contact E-mail:  
Contact Title:
Web Site:
Business Ownership Classification
Company Status:
Citizenship:
Gender:
Ethnicity:
Disabled/Veteran:
SIC Code: NAICS Code:
DUNS Number:
Business Information
Annual Sales $: For the year:   Projected Sales $:
Service Area:
Year Established:
Structure: Parent Company:
Incorporated:
Incorporated State:
If the company is a Public Entity, list the names of the principal owners:
Names:
Total Employees
Is the company listed with a business reporting service such as Dun and Bradstreet?
If yes, please provide appropriate reference number:
If not, please provide financial results information from previous 3 years. Provided separately.
Provide a copy of a current SAS 70 audit, if one exists. Provide separately.
Provide at least 3 credit references that PJM can contact:
Name: Phone:
Name: Phone:
Name: Phone:
Principle Products or Services
Certification Information
A) Has your company been certified by and regional NMSDC/WBENC purchasing council. If so, please list.
Council: Number: Date:   
B) Other agencies that have certified your firm as a minority, woman or disadvantaged business enterprise
Agency: Number: Date:   
Major Customers That You Do Regular Business With
Customer: Contact: Phone:
Customer: Contact: Phone:
Customer: Contact: Phone:
Comments:

Please provide information of the PJM Employee with whom you have been in contact.
First Name:
Last Name:
Phone:
Ex. xxx-xxx-xxxx
E-mail: