Supplier Diversity

Supplier Registration

Attachments must be 4 MB or less.
Required fields are bold.
 
For technical support with the form, call 713-439-0777 or e-mail tyco@aecsoftusa.com.
For questions about Tyco's Supplier Diversity program, call 609-720-4450 or e-mail supplierdiversity@tyco.com.

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Section I. Business Information

Company Information
Legal Company Name:
DBA Company Name:
D&B DUNS Number:
 
Physical Address:
 
City:
Country:
State / Region:
Zip / Postal Code:
 
Remit To Address:
 
City:
Country:
State / Region:
Zip / Postal Code:
 
Company Phone Number:  (Numbers only)  
Company Fax Number:  (Numbers only)
Company Website (URL):
 

Principal Owner Information
NameTitleE-mailGenderOwner Ethnicity% Control
 

Contact's Information
Contact Name:
Title:
Phone Number:  (Numbers only)  Ext.
Fax Number:  (Numbers only)
E-Mail Address:
 

Section II. Business Biography

Company Data
Business Type:
Legal Structure:
Please select all regions in which you can provide service:







What State and/or Country are you registered to collect tax?
Year Business was Established:
Number of Employees:
Business Classification:





If Minority Owned:
Are you SBA CCR listed?
If yes, what is your CAGE code:

Certification Information
Is your business presently certified as a MWBE with the National Minority Supplier Development Council (or local affiliate), Women's Business Enterprise National Council (or local affiliate), or government agency?
If your company is certified as MWBE, please list the certifying agency, and upload a copy of your certification.
 
Certification Type (1)
Certifying Agency
Certification No.
Expiration Date
Upload Certificate
 
Certification Type (2)
Certifying Agency
Certification No.
Expiration Date
Upload Certificate
 
Certification Type (3)
Certifying Agency
Certification No.
Expiration Date
Upload Certificate
 

Products and/or Services
Select Commodity Code(s)
To remove items from the list above, highlight the commodity code and click Remove From List button.
 
Select UNSPSC(s)
To remove items from the list above, highlight the UNSPSC and click Remove From List button.
 
Select NAICS Code(s)
To remove items from the list above, highlight the NAICS code and click Remove From List button.
Enter specific keywords describing your business specialty (up to 500 characters)

Annual Sales Volume

(numbers only, no comma or decimal point. I.E., 3000000)
2011
2010
2009

References
List three current business customers (local or otherwise) which have been or are now your customers:
Company NameContact NamePhone Number
Are you a current supplier to Tyco?
If yes, what Tyco Business Segment(s) are you working with?
Business Unit Contact Name Contact Email
Business Unit Contact Name Contact Email
Business Unit Contact Name Contact Email
Business Unit Contact Name Contact Email
Business Unit Contact Name Contact Email
Business Unit Contact Name Contact Email
Business Unit Contact Name Contact Email
 

Section III. e-Business Readiness
Do you have an online catalog? Can you sell your products/services online?


Are you Electronic Data Interchange (EDI) capable? Do you accept credit card payment? Select all that apply.



 
By choosing to submit this form, you certify that the information you have provided above is true and accurate.
 
Preparer's Name:
Preparer's Phone Number:  (Numbers only)  Ext.
Preparer's Email Address: