New Supplier Request Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Password must contain the following: 12 Characters 1 Uppercase letter 1 Lowercase letter 1 Number 1 Special character LEGAL BUSINESS INFORMATION LEGAL BUSINESS NAME D/B/A if different than above PHYSICAL BUSINESS ADDRESS StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Canada SALES CONTACT FIRST NAME SALES CONTACT LAST NAME OFFICE TELEPHONE SALES CONTACT EMAIL BUSINESS INFO BUSINESS TYPEPlease select... Individual / Sole Proprietor Partnership Corporation LLC Other YEARS IN BUSINESS TAX ID # / FEDERAL EIN SUPPLIER DIVERSITY Please select... MBE (minority) WBE (women) SBE (small biz) Certified B Corp Veteran Owned LGBTQ Owned Disability Owned Disadvantage Business Enterprise (DBE) Other NoneSELECT ALL THAT APPLY WEBSITE URL REQUIRED BUSINESS FORMS regardless of State Upload a copy of your W-9 Download W-9 Form if you do not have one Upload a copy of your Certificate of Insurance (COI) Read NCD's COI Requirements here DESCRIPTION OF SERVICE OR PRODUCT CURRENTLY SUBMITTING WHICH WOULD BEST CLASSIFY OUR RELATIONSHIP WITH YOUR COMPANY Please select... Your company will provide a Product or Products to NCD Your company will provide a Professional Service to NCD A Manufacturers Broker OtherSelect either that apply or both PLEASE ELABORATE ON THE PRODUCT OR PRODUCTS YOUR COMPANY WOULD LIKE TO PROVIDE TO NCD PLEASE ELABORATE ON THE PROFESSIONAL SERVICE YOUR COMPANY WOULD LIKE TO PROVIDE TO NCD OTHER? PLEASE EXPLAIN Your product could be best classified in the following category: (choose all that apply)Please select... Auto Better for You Beverage Bulk Confection Food Service General Merchandise Health + Beauty Pet Products Seasonal Snacks Store Supplies Technology Products Tobacco Vape, CBD, Hemp Are you willing to offer any of your products/services as an exclusive to NCD?YesNoMaybe If no, can you tell us the other distributors you work with or where else we can find your product/service: How did you hear about NCD?Please select... Industry Publication / Website Google / Internet Search Event NCD Employee Broker Friend Already an NCD Vendor in one Division Other Tell us which Industry Publication/Website, Event, Employee, NCD DIvision you are currently selling to or your Broker - so we can thank them! Will NCD be working with your broker?We are the BrokerYesNoMaybe BROKER INFORMATION Broker Business Name Address Line 1 Address Line 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Canada Postal Code Phone Broker Contact First Name Broker Contact Last Name Broker Contact Direct Phone # Broker Contact Direct Email Address SOCIAL MEDIA if applicable We are your partner and want to market your products/services. Growing your brand, strengthens our relationship. Tell us your social media profiles: TWITTER @ FACEBOOK URL INSTAGRAM @ SNAPCHAT @ YOUTUBE URL LINKEDIN URL PRODUCT, ORDERING & PAYMENT INFORMATION BACKORDERS?YesNo PAYMENT TERMS % Discount offered if paid within Terms Days PAYMENT TERMS DAYS # of days allowed to pay invoice for Discounted Terms eligibility. NET TERMS REQUESTED Please select... NET 7 NET 10 NET 14 NET 21 NET 30 IMMEDIATE OTHERInvoice Paid within mandated period. TERMS OTHER PAYMENT TERMS note UPLOAD NEGOTIATED OR PROPOSED VENDOR PROGRAM HAVE YOU ALREADY NEGOTIATED AN AGREEMENT WITH OUR PROCUREMENT, FOOD SERVICE OR EXECUTIVE TEAM? OR DO YOU HAVE AN ENTICING OFFERING? UPLOAD IT HERE! EMAIL ADDRESS TO SEND ORDERS TO: LEAD TIME: (IN DAYS) DAMAGE PROGRAM: Order Unit TypePlease select... Cases Pounds Pallets Dollars MINIMUM ORDER: NUMBERS ONLY (Put 0 if N/A or no minimum) MAXIMUM ORDER: NUMBERS ONLY DELIVERY POLICY / PROCEDURES (SHORTAGES, MISPICKS, DAMAGES, ETC.) DELIVERY POLICY UPLOAD RETURN & CREDIT POLICY INFORMATION DO YOU HAVE A PRODUCT GUARANTEE / CREDIT POLICY PRODUCT GUARANTEE - CREDIT POLICY UPLOAD OTHER RETURN POLICY INFORMATION THAT SHOULD BE NOTED RETURN POLICY UPLOAD REMIT PAYMENT INFORMATION TO PAYABLE TO REMITTANCE ADDRESS StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Canada A/R TELEPHONE A/R FAX A/R CONTACT FIRST NAME A/R CONTACT LAST NAME A/R EMAIL ADDRESS PAYMENT PREFERENCES Your Payment PreferenceCheckACHAmex One Check per PO?Please select... Yes No Doesn't Matter WIRE / EFT INFORMATION BANK ABA ROUTING # BANK ACCOUNT # BANK NAME BANK ADDRESS LINE 1 BANK ADDRESS LINE 2 BANK CITY BANK STATEPlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Canada BANK ZIPCODE EFT DISCLAIMER This is to certify that National Convenience Distributors (NCD) may credit, using established banking industry EFT procedures, the bank account identified above to effect payment for vendor invoices received in accordance with the sales terms of those invoices. CHECK BOX TO VALIDATE By checking this box, I understand that the submission of this form is simply a request to do business with NCD and not a guarantee that NCD will approve or accept the submission, partnership or service or product. YOUR NEW VENDOR SUBMISSION WILL NOT BE RECEIVED AND PLACED IN OUR APPROVAL QUEUE UNTIL THE "CHECK BOX" ABOVE IS SELECTED, "NEXT PAGE" BUTTON IS CLICKED AND THE SUBMIT BUTTON ON THE NEXT PAGE IS CLICKED TOO! National Convenience Distributors Purchasing Guidelines for SuppliersThe following purchasing terms are applicable to all suppliers of National Convenience Distributors (NCD).This document is not all inclusive and NCD has the right to adjust the requirements listed. In situations where the supplier’s policy is different from NCD, NCD Purchasing Guidelines will succeed. For further information, please contact NCD Purchasing Department. New Products Below are guidelines for new products. Supplier agrees to complete the New Item Form completely and accurately.Supplier agrees to pay NCD a $250 Administrative fee per new item. in addition to completing the New Item Form.Upon receipt of the New Item Number, supplier will email NCD a picture of the product. The picture must be sent as a High Resolution Image with the item number as the file name. This must be received at least 30 days prior to selling the product.Supplier guarantees all new products for a period 90 days. At the end of 90 days NCD and the supplier will reconcile all outstanding invoices and product to be returned.If the suppliers’ new products sell completely and a second order is required, the suppliers guarantee will continue until the 90 day period expires.If after 90 days a new product is not meeting the agreed upon sales targets, then the product can be discontinued by NCD. When a new or existing product has been active for 90 days or more, NCD may notify the supplier in writing to discontinue certain products. The supplier has 30 days to provide disposition instructions. At the end of 30 days, NCD will dispose the product and deduct the original cost of the product on the next payment to the supplier if NCD did not receive disposition instructions.Product Data Management Below are guidelines in order to properly capture the necessary information into our database.Supplier provides a complete case of new product(s) to NCD IT Department at least 1 week prior to NCD selling the merchandise. This will ensure the consistent entry of information in NCD database. Additionally, it allows us to relay accurate information to our customers and to better promote the merchandise. Merchandise is sent to the attention of:Director of IT Department National Convenience Distributors 21 Banfi Plaza Farmingdale, NY 11735 Any advertising material or literature describing the contents and/ or ingredients will be provided by the supplier.Samples will not be returned to the supplier, unless requested in writing and approved by the Purchasing Department in advance.Failure to comply may delay the availability of sale and delivery of merchandise to our customers and eventual rejection and cancellation of the purchase order.Swell Allowances Below are guidelines for swell allowances.Allowances for swell, spoilage, and damages are created to reimburse NCD for all unsaleable merchandise.Swell Allowances cover routine, day-to-day damages and spoilage.Swell Allowances do not cover discontinued products, recalls or defective products.NCD has the right to renegotiate Swell Allowances with suppliers if the Swell Allowances provided do not cover the cost of the product being processed or discarded.Recalls, Discontinued or Defective Products Below are guidelines for Recalls, Discontinued or Defective Products. The supplier will notify NCD of any recalls, discontinued or defective products in writing.The supplier is responsible for all costs of these products and removals.The supplier will reimburse NCD for the original cost of the items.The supplier will compensate NCD for any costs incurred by NCD.Certificate of Insurance A current Certificate of Insurance must be provided with the following:Workers’ Compensation – Statutory LimitsGeneral Liability (including products/ completed operations)- $2,000,000 General Aggregate- $2,000,000 Products/ Completed Operations Aggregate- $1,000,000 Each Occurrence- $1,000,000 Personal and Advertising InjuryCertificate Holder – National Convenience Distributors 21 Banfi Plaza Farmingdale, NY 11735Additional Insured – National Convenience Distributors and their respective Subsidiaries, Officers, Directors and employees of each are included as an additional insured.Policy Issued on Occurrence BasisAutomobile InsuranceMinimum 30 day written notice of cancellation or change in insurance coverage.As policies are renewed, a current COI should be issued to National Convenience Distributors.Miscellaneous Suppliers will provide NCD with Material Safety Data Sheets when applicable.NCD does not accept UPS freight.For more information, please contact NCD Purchasing Department. By signing this digital form, I acknowledge the Purchasing Guidelines and will abide by them. YOUR NEW VENDOR SUBMISSION WILL NOT BE RECEIVED AND PLACED IN OUR APPROVAL QUEUE UNTIL THE "SUBMIT" BUTTON IS CLICKED BELOW, YOU SIGN ON THE NEXT PAGE AND HIT THE FINAL SUBMIT BUTTON! Save my progress and resume later | Resume a previously saved form