Your Company Information
 
Company Name
Address


City, State/Province, Zip
Contact Name
Phone
(include area code)
E-mail
Internet Address
Type of Product(s) or Service(s) offered (Check all that apply) 01 - Electrical Equipment & Supplies
02 - Data Communications
03 - Hand and Power Tools
05 - HVAC
06 - Lighting/Ballasts
07 - MRO/Industrial Supplies/Safety
08 - Plumbing, Pumps, Hoses, and Accessories
09 - Power Transmissions/Motors
10 - Wire/Cable/Conduit
Company Type
Year Business Established

Annual Sales
(past 3 years)

 Begin with the most recent complete fiscal year

Year 1
Year 2
Year 3
 
Geographical Service Area
(check all that apply)		 West Coast (CA, OR, WA, ID, NV, AZ, UT)

South Central (CO, TX, OK, LA, MS, MO, NM, AR)

North Central (IL, IN, MI, OH, WI, IA, KS, NE, WY,        SD, ND,MT, MN)

Southeast (AL, FL, GA, KY, MI, NC, SC, TN)

Northeast (DE, MD, PA, VA, WV, NY, NJ, CT, ME,        MA, NH, RI, VT, DC)

International
 
Standard Industrial Classification System (SIC) Code 1.
2.
3. 		4.
5.
6.
 
Federal Tax ID#
Number of Employees
Number of Minority Employees
Supplier Cash Discount/Payment Terms
Product(s) To Be Purchased
Estimated Monthly Purchase Amount/Purchase Orders Per Month
Will the branch be stocking this material?
 
 
Please fax the following REQUIRED Supplier Documents to Supplier Diversity Coordinator at
FAX: 412-454-4765.

(These documents must be sent in order to complete the registration process.) 		Required Documents:
  • Return Policy/Warranty
  • Copy of Invoice or Remit proof
  • Certificate of Insurance/Product Liability
(On your Certificate of Insurance, you must define WESCO as a certificate holder. Please refer to WESCO as: WESCO Distribution, Inc., Suite 700, 225 West Station Square Drive, Pittsburgh, PA 15219-1122)
 
Company Classification
 
Classification of Your Business
If you have questions, contact the nearest US Small Business Administration (SBA) office for guidance.
Check all that apply Minority-Owned Business Enterprise 1
        African American
      Asian Indian American
      Asian Pacific American

Hispanic American
Native American
Multi-Cultural, Other
  Women-Owned Business Enterprise 2
Small Disadvantaged Business (SDB)
Disabled Owned
HUBZone
8(A) Designation
Disadvantaged Veteran Enterprise (DVE)
Disabled Veteran Business Enterprise (DVBE)
Service Disabled Veteran (SDV)
Veteran Business Enterprise (VBE)
Vietnam Veteran
Historically Black Colleges and Universities and Minority Institutions
 

1     MINORITY BUSINESS ENTERPRISE, means a business that (1) is at least 51 percent owned by one or more minority individuals, or a publicly owned business having at least 51 percent of its stock owned by one or more minority individuals, and (2) that minority person or persons is actively involved in the day to day management and operation, AND is involved in policy decision-making.

2     WOMEN-OWNED BUSINESS ENTERPRISE, means a business that (1) is at least 51 percent owned by a woman or women or a publicly owned business having at least 51 percent of its stock owned by one or more women, and (2) that woman or women is actively involved in the day to day management and operation, AND is involved in policy decision-making.
Principal Owner(s) (please fill in at least one)
  Name Title % Ownership
1.
2.
3.
List 3 Customer References
  Company Name Contact Name Telephone Email
1.
2.
3.
Has your business been certified as minority or women owned by any government agency or private agency?  
Yes    No
If yes, then please select the name of the certifying organization:
If you selected "other" please fill in the name of the certifying organization:
I certify to WESCO that the information provided is true and correct and that I will advise WESCO if our classification should change:
Yes    No