ROMAN COMPANY
NEW VENDOR FORM
VENDOR INFORMATION
* VENDOR NAME
SEARCH TYPE
V= VENDOR
BUSINESS
UNIT 00001
* VENDOR ADDRESS
ADDRESS 1
ADDRESS 2
ADDRESS 3
CITY
STATE
POSTAL CODE OR ZIP CODE
* COUNTRY
Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Côte d'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom
USA Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe
COUNTY
* TELEPHONE NUMBER
FAX NUMBER
CONTACT NAME
E-MAIL ADDRESS
WEBSITE, IF APPLICABLE
* FACTORY NAME
* FACTORY ADDRESS
ADDRESS 1
ADDRESS 2
ADDRESS 3
* CONTACT NAME & TITLE
* FACTORY TELEPHONE
NUMBER
* FACTORY E-MAIL ADDRESS
IF YOUR FACTORY HAS BEEN EVALUATED BY A
THIRD PARTY AUDITING COMPANY WITHIN THE LAST 12 MONTHS
PLEASE PROVIDE THE NAME(S) OF COMPANY(S) WHICH PERFORMED THE EVALUATION AND THE
STATUS OF EVALUATION(S).
EVALUATION 1
Company Name:
Date of Evaluation:
Status:
Passed
Failed
If Failed, Why?
EVALUATION 2
Company Name:
Date of Evaluation:
Status:
Passed
Failed
If Failed, Why?
EVALUATION 3
Company Name:
Date of Evaluation:
Status:
Passed
Failed
If Failed, Why?
EVALUATION 4
Company Name:
Date of Evaluation:
Status:
Passed
Failed
If Failed, Why?
PROPOSITION 65
Have you reviewed the proposition 65
letter?
Prop 65 Letter English
Prop 65
Letter Chinese
Prop 65
Letter Italian
* please answer YES or NO
Have you signed and submitted the
*
please answer YES or NO
Fax Number 314-968-5483 or e-mail to:bradley.fields@romancompany.com
All of the forms abovementioned forms
C-TPAT (Customs Trade Partnership Against Terrorism)
Have reviewed, and will adhere to the C-TPAT
*
please answer YES or NO
*
please answer YES or NO
*
please answer YES or NO
*
please answer YES or NO
Fax Number 314-968-5483 or e-mail
to:bradley.fields@romancompany.com
All of the forms abovementioned forms
ORDER CONFIRMATIONS:
ORDER CONFIRMATIONS FOR PURCHASE ORDERS
ISSUED BY ROMAN COMPANY ARE REQUIRED WITHIN ONE WEEK OF RECEIPT OF
PURCHASE ORDER. ORDER CONFIRMATIONS MUST STATE QUANTITY, STYLE NUMBERS AND
DESCRIPTIONS, INSTRUCTIONS, PRICES AND EXPECTED SHIP DATE. ANY ADDITIONAL
PACKAGING, MOUNTING, FREIGHT, ETC. CHARGES MUST BE INCLUDED IN COST
REFLECTED AT ITEM LEVEL ON ORDER CONFIRMATION.
WILL
SUPPORT MATERIAL BE SHIPPED TO VENDOR?
YES
NO
PURCHASE ORDER TERMS:
FOB POINT, DESIGNATED FREIGHT FORWARDER
PROVIDED BY ROMAN COMPANY.
PAYMENT MADE UPON RECEIPT OF GOODS AND
QUALITY CONTROL APPROVAL AT ROMAN FACILITY. WIRE PAYMENTS ARE MADE TO
FOREIGN VENDORS. ANY DEVIATIONS TO THESE TERMS MUST
HAVE PRIOR APPROVAL.
PAYMENT INFORMATION
PLEASE CHECK APPLICABLE FORM OF PAYMENT.
WIRE TRANSFER OF FUNDS (overseas
vendors only)
WIRES ARE MADE WEEKLY, UPON RECEIPT
AND PASSING QC OF VENDOR'S SHIPMENT. THIS APPLIES TO REGULAR PRODUCT AND
SAMPLES. VENDOR MUST PROVIDE A DEBIT NOTE FOR EACH SHIPMENT, WHICH MUST
INCLUDE THE FOLLOWING INFORMATION: AWB NUMBER, DATE OF SHIPMENT, AND
ITEMIZED LIST OF EACH PO INCLUDED IN SHIPMENT, QTY SHIPPED OF EACH PO,
DOLLAR AMOUNT DUE ON EACH PO AND GRAND TOTAL DUE FOR THAT DEBIT NOTE.
DEBIT NOTES SHOULD BE FAXED TO ATTN: SHARON YINGLING.
DOMESTIC VENDOR TERMS
INDICATE THE PAYMENT TERMS FOR DOMESTIC
VENDORS
TAX ID NUMBER:
DISCOUNT:
YES NO
(IF NO, PLEASE INDICATE REASON BELOW)
BANK INFORMATION
THE FOLLOWING INFORMATION IS REQUIRED FOR
WIRE TRANSFERS.
BANK NAME
BANK ADDRESS
ADDRESS 1
ADDRESS 2
VENDOR ACCOUNT
ROUTING#
BENEFICIARY:
FORM COMPLETED BY:
DATE:
MAX ORDER VALUE
INITIAL ORDER VALUE - SAMPLES
* SUBMITTED BY
DATE:
EMPLOYEE NAME
*
Please note that fields with an asterisk are required for submission
