Potential Supplier Questionnaire

Graybar purchases products for resale to other businesses. If you are interested in Graybar distributing your products, complete our Potential Supplier form and a Graybar representative will contact you.

* All fields are required.

Questionnaire

Company Info

Company Name: *

Website *

Your Name *

Address

Address Line 1
*

Address Line 2

City *

State *

Postal Code *

Phone *

Email Address *

Product Information

Choose your primary
product offering:

Description of Product

Disclosures

Is your company incorporated in the U.S.? Yes No

If yes, Date: *

Total Years in Business: *

Are you fully prepared to disclose one of the following:

A. Last two years audited fiscal financial statements? Yes No

B. Last two years CPA prepared and reviewed fiscal financial statements, including an income statement, balance sheet, cash flow statements, and applicable notes? Yes No

Are you able to provide insurance ($5 million per occurrence for products/completed ops)?
Yes No

D&B Number: *

US Point of Shipping Products: *