NEPIRC Supplier Scouting Request Form

Name(Required)

First Last

Company(Required)

Email(Required)

Website

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Item to be Scouted:(Required)

Item Descrption:(Required)

Days to be scouted:(Required)

State item to be used in:(Required)

Type of supplier being sought:(Required)

Reason:(Required)

a. Describe the manufacturing process (provide as much detail as possible):(Required)

b. Provide dimensions / size / tolerances / performance specifications for the item:(Required)

c. List required materials needed to make the product, including materials of product components:(Required)

d. Are there applicable certification requirements?

e. Are there applicable regulations?

f. Additional technical comments:

Estimed potential business volume:(Required)

Estimated target price/ unit cost information (if unavailable, explain):(Required)

When is it needed by?(Required)

Describe packaging requirements:(Required)

Where will this item be shipped?(Required)

Is there any other information you would like to include?

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