Supplier Registration Information

* Required fields are bold.

 

Section I. Business Section

Legal Company Name:
DBA Company Name:
User Name:
Federal Tax ID:
D&B DUNS Number:
 
Physical Address
  Address:
   
  City:
  Country:
  State / Region:
  ZIP / Postal Code:
 
 
Mailing Address
  Address:
   
  City:
  Country:
  State / Region:
  ZIP / Postal Code:
 
Company Phone Number:
Company Fax Number:
Company Website (URL):
 

Principal Owner Information

Owner 1
  Name     Title     E-mail
     
  Gender   Owner Ethnicity   % Ownership
     
Owner 2
  Name     Title     E-mail
     
  Gender   Owner Ethnicity   % Ownership
     
Owner 3
  Name     Title     E-mail
     
  Gender   Owner Ethnicity   % Ownership
     
 

Contact Information

Contact Name:
Title:
Phone Number:
 Ext.
Fax Number:
E-Mail Address:
 
 

Section II. Business Biography

Company Data

Business Type:    
Legal Structure:
 
Geographical Service Areas:
 
List the major airports locations/cities you have branch locations or operations.
Please Click Here To Select Airports.  
 
To remove items from the list above, highlight the item and
click the Remove From List button.
 
 
Year Business was Established:
Number of Employees:
 
Select UA Categories  
 
To remove items from the list above, highlight the item and
click the Remove From List button.
 
 
Select Primary NAICS Code  
 
 
 
Select Secondary NAICS codes  
 
To remove items from the list above, highlight the item and
click the Remove From List button.
 
 
Describe the Product Lines / Services your company provides using keywords:
 
Annual Sales For 2013:
Annual Sales For 2012:
Annual Sales For 2011:
 

References

Reference 1
  Company Name   Contact Name   Services Provided (50 character limit)
     
  Phone   Email
   
Reference 2
  Company Name   Contact Name   Services Provided (50 character limit)
     
  Phone   Email
   
Reference 3
  Company Name   Contact Name   Services Provided (50 character limit)
     
  Phone   Email
   
 
How did you find out about our program?
Does your company have the authority to operate at any airport?
Does your company have a documented quality control program?
Is your company Union?
Does your company possess all the licenses and/or permits required by local, state and federal authorities applicable to your business?
 
Plant/Warehouse size (total square feet)
Equipment used
 
Attention: Upload file size needs to be 1MB or less.
Automobile Liability
Company Name:
Limit:
Expiration Date:  ...
Upload Insurance:
  
 
Comprehensive General Liability
Company Name:
Limit:
Expiration Date:  ...
Upload Insurance:
  
 
Single Bonding
Company Name:
Limit:
Expiration Date:  ...
Upload Insurance:
  
 
Total Bonding
Company Name:
Limit:
Expiration Date:  ...
Upload Insurance:
  
 
 

Section III. Business Classifications

Certification Information

If your company is certified as MWBE, please list the certifying agency, and upload a copy of your certification.
 
 

Additional Questions

 
Are you currently providing a product/service to United?
 
 

Section IV. E-Business Readiness

Are you Electronic Data Interchange (EDI) capable?

 

False Representation of Business Statement

I certify under penalty of perjury, that the foregoing statements are true and correct and include all material information necessary to identify and explain the operation of   as well as the ownership thereof. If owner classification checked indicates a minority-owned or woman-owned business, the operated undersigned also certifies that this company is at least 51% owned, operated and controlled by minority individuals or women. If business is awarded under these circumstances, you will be required to provide proof of status through an acceptable third party certification. The firm also understands that it is your responsibility to notify us if your classification should change. ANY MATERIAL MISREPRESENTATION OF INFORMATION IN THIS DOCUMENT WILL BE GROUNDS FOR TERMINATING ANY CONTRACT WHICH MAY BE AWARDED AND FOR INITIATING ACTION UNDER FEDERAL AND STATE LAWS. I also understand the submittal of this form does not guarantee business with United or its affiliated divisions.
 
Preparer's Name:
Preparer's Phone Number:
  Ext.
Preparer's Email Address: