Request to become an approved supplier

Please complete the following form and press submit. Make certain to pay close attention in selecting a 'Primary Product or Service' because this determines which person within NCR will receive your information for review. Please note that your submission of this profile information is for initial consideration purposes and does not guarantee any future business relationship with NCR. Your profile information is for NCR use only and may be retained for reference as future business opportunities arise. Thank you for your interest in NCR.

The fields identified by (*) are required.

Supplier:

Supplier Name *
If Subsidiary, parent name

Supplier Address Information:

Street Address *
City *
State
Postal code *
Country *

Web Address

Contact Information:

Contact Name *
Contact Email *
Contact Telephone *

Supplier Details:

Primary Products or Services *

Long description of Products or Services:

Size of Company *
Number Employees *

Year Started *

Regions covered * (select all that apply)
Major Markets served * (select all that apply)

Supplier Diversity Information:

To qualify as a Minority Supplier, a company must be at least 51% owned and controlled by one or more U.S. citizens from any of the following ethnic groups: African American, Hispanic, Native (including Eskimo and Native Hawaiians) and Asian Americans. Women Owned Businesses must be 51% owned, managed and controlled by U.S. citizens.

People with Disabilities must be 51% owned managed and controlled by disabled, or disabled veterans organizations that employ a substantial number of people with disabilities, and be U.S. citizens. Please refer to www.sba.gov for requirements to qualify as an HUB Zone, Veteran-owned or Small Disadvantaged Business.

Does your business qualify as a diverse supplier?	Yes No
If Yes above (select all that apply)

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