ࡱ> <; \p Jean Kuehneln Holcombe Ba==h<L,8X@"1Arial1Arial1Arial1Arial1.Times New Roman1.Times New Roman1.Times New Roman1.Times New Roman1.Times New Roman1.Times New Roman1.Times New Roman1.Times New Roman1Arial1Arial1.Times New Roman1.Times New Roman"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                + ) , *    #      H+  H+   + &x+ !x+  @ @ + "x+ #@ @ +  h+    (     (` &X+  H     h   (  (   (  &X+  ! &  H           @+   H+  h@@+  h@+  h @+  h@+  h +  h@ +  h +  h +   (  @  (@  " @   (  (   (  !8  (   (  (  "x+   "X+  8@  8  ( ( (8 (0 (0 (   `BI-LO DSD Supplier Form< Instructions  ;3 }`DateBI-LO Office Use OnlyGroceryGm/HBC Beer/WineProduct CategoryVENDOR/SUPPLIER INFORMATION%REPRESENTATIVE INFORMATION (Mail to):NAMEADDRESSCITYSTATEZIP CODEPHONEDUNSFAXAUTOFAXCONTACT EMAIL ADDRESSUCS# EDI CAPABLEYESNO EDI CONTACT EDI PHONEEDI FAXCASH DISCOUNT TERMSPercentDays Net/GrossDate of the MonthContact Enter the contact person's name.(Enter the DUNS # if you are EDI Capable.USC #-Enter the Universal Communication Standard #. Email Address.Enter the Email address of the contact person.)REPRESENTATIVE INFO (Mailing Information) Autofax # EDI CapableEnter Y (Yes) or N (No) EDI ContactEnter the contact person EDI PhoneFEnter the phone number (including the area code) of the contact personEDI FaxEEnter the fax number (including the area code) for the contact personEnter the contact person's namePhoneGEnter the phone number (including the area code) for the contact person3Enter the % of discount if cash is used for paymentDay(s)Enter the number of daysEnter the date of the monthEnter N (net) or G (gross)   STORE SERVICE B I - L OGrocery/ GM/HBC HCheck the box pertaining to which department the item is categorized in.!Negotiator's Signature (required)Treasury Department NotesA(If no certificate of insurance the vendor will not be activated)6(Must be at least a 3 or vendor will not be activated)Accounting Signature (required) Supplier #0If this supplier services ALL stores, check here#Store #s serviced by this supplier:S U P P L I E RSUPPLIER INFORMATIONOList the store numbers of those particular stores serviced by the DSD supplier.2Enter the supplier # for this particular supplier.=Check the box if ALL stores are serviced by this DSD supplierAIs a "Certificate of Liability Insurance" attached? Yes __ No __ (1D & B Scoring ___________________________________1_________________________________________________6If no D&B Scoring, references needed (can be attached)*BILLING INFORMATION (remit to information) EMAIL Fed ID/SSNQ(required if 1099 supplier/Unincorporated suppliers paid more than $600 annually)HoldbackYes ___ No ___*BILLING INFORMATION (remit to information)Email.Enter the email address for the contact personnEnter the AutoFax Number (including area code). If the number is a local number, the area code should be 000.mEnter the name, address, city, state, zip code, and phone number ( including area code) of the representative{Enter the company name, address, city, state, zip code, phone number and fax number to whom the billing needs to be sent tolEnter the Product Category for the item (ie, if the item is Coors Light, the product category would be BEER)mEnter the company name, address, city, state, zip code and phone number (including area code) of the supplier"Enter a check beside one Yes or No_Enter if you are a 1099 supplier or Unicorporated supplier that is paid more than $600 annually>Authorizer's Signature (required) (Must be Director or higher) Supplier's Signature (required*) -*Supplier's signature is not required for PPOZZ 1r5_ar={-a   8"Н0 0ip0 8 8:0 T0Z t i 8T0t00`#d#'zm00  E000   ߿0  8 t08HPercent0]8(0\w0{T0T00Twe0Twբ0Tw|wwW|`T0T0T0W|GW|$$W|9W|`w`T0`T0`T0xÆ0`T0Ǭp0p0088,;88S]0818w$8P%0HHa0dHN ` h-0N  4O*7C<  dMbP?_*+%@=&C&"Arial,Bold"&11BI-LO DSD Supplier Form&"Arial,Regular"&10 &?'?M \\b0maups1\003)W odXLetterCanon $ Canon iR330-400-P1/R1 PCL5edddd     ddd@@d     dd d     d d"  edddd     d!d     ddA     A d8o @@/ o @@/ d2CONFIDENTIALCONFIDENTIALHArial AXX\SRGBCO~1.ICM\SRGBCO~1.ICM\SRGBCO~1.ICMDefault Settings22"cX??U} } } } m } } m} $} m} $} } $} } m4wwGi      0lT0   & A  MI NNNNNN  O> OOOOOO     !  6J 5!!!  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"  # $ % &  ( ) * + , - . /  0 1 2 0 )Q [ ####* !-O!# !U\!VVVVVV* "+,WWWWWWW* #-#EEEEEEE* $)8$( %) %H%( &+, &,F&,,,,,,( (.9(........( ))A) )G)( *)( +/:+0( ,/,0 ,;,( -/0( .H.I .UY.VVVVVV1 /JKWWWWWWW1 02$3$$$$$$1 12$3$$$$$$1 22$$$$$$$$1 (jT4>*44*>*>>>@  2./!"   Oh+'0HPx Vendor Form DSD - 04/05/2004sofB235r FB235r FMicrosoft Excel@E("@pT՜.+,D՜.+,0 PXl t|  BI-LO LLCo1 BI-LO DSD Supplier Form Instructions  Worksheets 6> _PID_GUIDAN{45215202-0CC1-4944-B240-F712865D8E10}  !"#$%&'()*,-./012456789:Root Entry FnVlWorkbookmUSummaryInformation(+DocumentSummaryInformation83