Supplier Form

Company Information:

Legal Company Name *

Business Registration/License Number *

Tax Identification Number (TPIN/VAT) *

Type of Business *

Primary Industry Category *

Primary Contact Details:

Full Name of Contact Person *

Position/Title *

Direct Phone Number *

Email Address *

Physical Business Address *

Company Website (Optional)

Banking & Payment Information:

Bank Name *

Branch Name and Code *

Account Holder Name *

Account Number *

Standard Payment Terms *

Mobile Money Number (Optional)

Compliance & Offerings:

Certificate of Business Registration/Incorporation *

Valid Tax Clearance Certificate *

Recent Proof of Address *

Specialized License/Certification (If applicable)

Detailed Description of Products/Services Offered *

Current Price List/Catalogue (Optional)