CVS Supplier Information Form

CVS Supplier Information Form Supplier to Complete all White Fields Where Applicable CVS to Complete all Gray Fields Where Applicable New Supplier Info Supplier # ______ Remit Supplier # ______ Changing Info for Existing Supplier Supplier # ______ Choose One: DSD Supplier Import Supplier Warehouse Supplier Expense Supplier Section 1 – All Suppliers to Fill Out White Areas Remit Address Supplier Name ________________________________________ DBA Address 1 Address 2 ________________________________________ ________________________________________ ________________________________________ PO Address Name _______________________________________________ Street _______________________________________________ City ___________________ Zip ___________________ State _________________ Country _________________ City ______________________________________________ State ______________________________________________ Zip ______________________________________________ Country ______________________________________________ Sales Rep _____________________________________ Sales Rep Email ______________________________________ Corporate Phone ______________________________________ AR Phone DUNS # ______________________________________ ______________________________________ Category Manager Code _ Category # ___ FMM Code ___ Co-Op Ad Code _ 1 = Adv in any warehouse fulfills adv. Req in all warehouses. 2 = Each warehouse is required to advertise on initial buy made for that warehouse. 3 = Adv is req for all buys made by a warehouse. 4 = adv in one or more specific warehouse fulfills req in all warehouses. 5 = Adv subject to certain exceptions. 9 = Supplier does not offer co-op adv allowance. FOB/FFA/Prepaid (Freight Terms) __ 1 = FOB (Free on Board) 2 = FFA (Full Frt Allowance) 3 = Prepaid (Import Suppliers Only) Choose One: FOB Destination Ship Point   Order Multiple _ C = Cases D = Dozens P = Pieces Min Units Multiple _ C = Cases Z = Dozens P = Pieces L = Pounds Minimum Dollars _____ Minimum Units _____ Payment Terms _______________ DSD/Expense Supplier Only Pay Group _____ Tax ID # ___________ Employee: Yes  No  Section 1 (End) W = Write Off: CVS absorbs the cost of damages, or Supplier pays off-invoice allowance D = CVS deducts Damage from the next payment to Supplier C = Supplier sends check to CVS Damage Disposition Code__ Damage Payment Type _ DO = Donate VP = Supplier Pickup SV = Supplier Return SI = Dispose Section 2 - Warehouse and DSD Suppliers Only Seasonal  Category # _____ Hold 30 % of Spend $ _____ Product Description ______________ Credit Application Attached Certificate of Liability Attached Yes  Yes  No  No  Section 2 (End) CVS Supplier Form Ver 3.doc 05/29/2007 JMC 1 of 7 Section 3 - DSD Suppliers Only 3a General Information Does Supplier provide bracket pricing? Does Supplier pay freight? Yes  Yes  No  No  All Store Supplier: Drop ship: Yes  Yes  No  No  Detail  or Summary  Supplier? (CM/FMM to assign) Gross Margin % _____ (CM/FMM to assign) If applicable, all related CVS Corp 1 Supplier #s: (must list all) ______________________________ Acount Mgr ________________________ AR Manager ________________________ Phone ____________________ Phone ____________________ Email ___________________________________ Email ___________________________________ CVS Merchant Contact Name: ________________________________________________ 1. All delivered product has a UPC/EAN on product? 2. Does cost of product vary by CVS store location? 3. Do you send EDI 810 transmissions to CVS? 4. Do you have internet access? 5. Are representatives of your company always present for delivery during normal business hours? 6. Do you use DEX (Direct Exchange) technology with other retailers? Yes  Yes  Yes  Yes  Yes  Yes  No  No  No  No  (If yes, fill out Vendor Portal Security Form) No  No  (If yes, fill out Section 3c) DEX Technology utilizes a handheld unit for electronic exchange of invoice data at time of delivery. 3b SBT Information If your company is interested in the CVS SBT program, please send an email to the SBT mailbox at SBT@cvs.com. 3c DEX System Information Communication ID: ____________________ *DUNS # : ____________________ *(Data Universal Numbering System. Unique 9-digit number assigned to your company by Dun & Bradstreet used as an identifier in electronic data interchanges.) DEX System Contact Information: DEX Contact name: ____________________ DEX Tech Phone: ___________ DEX Tech Email: ________________________ DEX Unit Information: DEX Hardware manufacturer/model: ___________________________________________ DEX Software vendor/version: ___________________________________________ CVS is only DEX version 4010 capable at this time. Do you have Yes  No  plans to upgrade to DEX version 5010? If yes, Expected date of upgrade: ___________________________________________ Section 3 (End) CVS Supplier Form Ver 3.doc 05/29/2007 JMC 2 of 7 Section 4 – All Applicable Suppliers to Fill Out Electronic Delivery of PO/Invoices (810/894) Information Import EDI Contact Yes  No  EDI Capable Yes  No  ________________________________________ EDI Customer Service Contact ___________________________ Email Address ________________________________________ Phone Fax ____________________ ____________________ Email Address ________________________________________ Phone Fax ____________________ ____________________ Fax number to send Purchase Orders before EDI setup takes place _____________________ *For more information regarding EDI requirements for CVS, please visit http://www.cvssuppliers.com/. Section 4 (End) Section 5 - Warehouse Suppliers Only Merchandise Return Address Warehouse Return  Check if same as:  Remit Address  PO Address Name _______________________________________________ Street _______________________________________________ City ___________________ Zip ___________________ State __________________ Store Return  Check if same as:  Remit Address  PO Address Name _______________________________________________ Street _______________________________________________ City ___________________ Zip ___________________ State __________________ Country __________________ Country __________________ Ship From Address *Where merchandise is shipping from. If product ships multiple locations, utilize Ship from Address 2. Address 1 Warehouse Contact Name _______________________________ Address _____________________________________________ City Zip Phone _________________ _________________ ____________________ State __________________ Country __________________ Address 2 Warehouse Contact Name _______________________________ Address _____________________________________________ State __________________ City _________________ Zip Phone _________________ ____________________ Country __________________ Backhaul Data *Required to identify program availability and central point of contact. Do you offer a backhaul program from Address 1 above? Do you offer collect pricing? Phone ____________________ Beer and Wine Product (If checked, send a copy to Inventory) Fintech Partner Yes  Yes  No  No  Do you offer a backhaul program from Address 2 above? Do you offer collect pricing? Phone ____________________ Section 5 (End) Item to send copies to the following departments: ECR, Logistics, & DSD. Date _____________ Date _____________ Date _____________ Date _____________ Yes  Yes  No  No  Backhaul Contact Name ________________________________ Backhaul Contact Name ________________________________ Requested By Supplier Signature CVS Authorized Signature CVS Financial Approval Signature (Required for DSD Suppliers Only) CVS Supplier Form Ver 3.doc 05/29/2007 JMC __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ 3 of 7 CVS New Supplier Information Form Instructions Supplier to complete ALL White Fields on actual CVS New Supplier Information Form. CVS to complete ALL Gray Fields on actual CVS New Supplier Information Form. Purpose: Form Locations: To establish a new Supplier number. Supplier #’s are Category Manager specific. The form can be accessed  On-line from the forms directory on the common drive. The form name is g:\Common\Forms\CVS New Supplier Information Form  On-line on the EDI website www.cvssuppliers.com  Or hard copy at the Security desk in the Store Support Center Generated systemically on-line at time of set up. Manually entered on form. CM/AP enters this number when there are multiple PO Supplier numbers and a central payment Supplier. Supplier #: Remit Supplier #: Choose One: DSD Supplier Import Supplier Warehouse Supplier Expense Supplier Indicates the type of Supplier Section 1 Remit Address: Supplier Name DBA Address 1 Address 2 City/State Zip Country PO Address: Name Street City/State Zip Sales Rep AP Phone # Corporate Phone Category Manager Code: FMM Code: FOB/FFA/Prepaid: Payable address  Company name  If different from Supplier name, the name the Supplier is Doing Business As  Street address where payment is sent  Additional street info or PO box where payment is sent  City, state where payment is sent  Zip code where payment is sent  Country, if other than USA Purchase orders are sent to this address  Name where PO is sent  Street address where PO is sent  City/state where PO is sent  Zip code where PO is sent  Person to contact about account  Contact number for collection purposes  Contact number to reconcile account 1 numeric or alpha digit code for the Category Manager 3 numeric digit for the Field Marketing Manager How merchandise will be shipped to warehouse-freight or transportation charge. 1 numeric digit code  1 = FOB (Free on Board)  2 = FFA (Full Freight Allowance)  3 = Prepaid Co-Op Ad Code: CM to negotiate w/Supplier 1 numeric digit code  1 = Advertising in any warehouse fulfills advertising requirements in all warehouse.  2 = Each warehouse is required to advertise on initial buy made for that warehouse.  3 = Advertising is required for all buys made by a warehouse. CVS Supplier Form Ver 3.doc 05/29/2007 JMC 4 of 7    Order Multiple: 4 = Advertising in one or more specific warehouse fulfills requirement in all warehouses. 5 = Advertising subject to certain exceptions. 9 = Supplier does not offer co-op advertising allowance. The multiple at which orders will be created  C = Cases  D = Dozens  P = Pieces Minimum order quantity . What minimum units are multiplied by  C = Case  Z = Dozens  P = Pieces  L = Pounds Minimum $ amount that supplier will ship per PO. Payment terms. Ex. Net 30 days is entered as a 2 digit field (30). Up to 5 fields. 2 digit alpha code  DO = Donate  VP = Supplier Pickup  SV = Supplier Return  SI = Dispose 1 digit alpha code  C = Supplier sends check to CVS  W = Writeoff: CVS absorbs the cost of damages, or Supplier pays off-invoice allowance  D = CVS deducts Damage from the next payment to Supplier AP enters this for payment criteria. Company’s tax identification number. AP uses for taxable entities Suppliers/Expense/Supplies = N, CVS Employee Payment = Y. AP uses to identify payments for Travel & Entertainment reports. Section 1 (End) Check box if seasonal merchandise only. General description of product. Attach credit application if supplied. Attach Certificate of Liability if supplied. Section 2 (End) Minimum Units: Minimum Units Multiple: Minimum Dollars: Pay Terms: Damage Disposition Code: Damage Payment Type: DSD/Expense Supplier Only Pay Group: Tax ID #: Employee Y/N: Section 2 Seasonal Product Description Credit Application Attached Certificate of Liability Attached Section 3 a Does Supplier provide bracket pricing? Y/N All Store Suppliers Y/N Does Supplier pay freight Y/N Drop ship Detail or Summary Supplier Gross Margin % CVS Corp 1s Yes, if supplier provides different cost based on quantity/volume. Yes, if supplying all stores. Yes, if supplier pays freight charges. CM assigns type. Warehouse product being delivered direct to the stores by the supplier or other third party. CM assigns type. Average GM of product. CVS assigned Unique supplier identifier - 4 digits - all numeric located on all checks from CVS. CVS Supplier Form Ver 3.doc 05/29/2007 JMC 5 of 7 Account Mgr & Contact Info AR Mgr & Contact Info CVS Merchant Contact Name UPC on product? Cost of product vary by CVS store location? Send EDI 810 transmissions to CVS? Internet access? General Contact for CVS. Payment contact for CVS. Supplier’s main contact. UPCs need to be on all product. Informational purposes. Informational purposes. Suppliers with internet access will utilize the CVS Supplier Portal to submit cost changes or research invoice cost discrepancies and therefore must submit a Security Authorization Form. Informational purposes. Suppliers indicating that they have DEX technology must be present at delivery and possess a handheld unit that is utilized to electronically transmit invoice data, at time of delivery. All DEX suppliers are required to supply their Comm ID and DUNS #, a unique 9- digit numeric identifier, assigned to your company by Dun & Bradstreet for use in electronic data interchanges. We do not require your Location Code. Present for delivery during normal business hours? Do you use DEX (Direct Exchange) technology with other retailers? Section 3b SBT Information Listed in this section is the SBT mailbox for inquiries your company may have on the SBT program. Section 3c Communication ID & DUNS # DEX Contact Information DEX Unit Information Plans to upgrade to DEX version 5010? Data Universal Numbering System. Unique 9-digit number assigned to your company by Dun & Bradstreet used as an identifier in electronic data interchanges. DEX technician for certification and troubleshooting. Manufacturer of DEX handheld unit, model, and software version. CVS does not currently support version 5010 and will not be compatible. Informational purposes to determine when CVS should upgrade. Section 3 (End) Section 4 Information for Electronic Delivery of PO EDI Info Import Y/N EDI Capable Y/N EDI Contact Fax# Email Address Phone # EDI Customer Service Info Contact Name Import company = Y, domestic company = N Can company receive POs electronically – yes/no Person to contact concerning electronic delivery of POs Fax# of EDI contact Email address of EDI contact Phone # of EDI contact Customer Service contact Email address of customer service contact Fax# of customer service contact Phone # of customer service contact Needed in order to setup EDI Email Address Fax# Phone # Fax number to send Purchase Orders before EDI setup takes place Section 4 (End) Section 5 Merchandise Return Address Where merchandise will be returned. Entered on MCR screen #10072. Warehouse Return CVS Supplier Form Ver 3.doc 05/29/2007 JMC 6 of 7 Name, Street, City/State Zip, Phone The address to return merchandise from the warehouse. Store Return Name, Street, City/State Zip, Phone Ship From Address Address 1 Warehouse Contact Name, City/Date, Zip, Phone# Address 2 Warehouse Contact Name, City/State, Zip, Phone # Do you offer a backhaul program? Y/N Contact Name and Contact Phone # Do you offer collect pricing? Y/N Contact Name and Contact Phone # Section 5 (End) Beer and wine product Fintech Partner Item to send copies to the following departments: Requested by: Supplier Signature CVS Authorized Signature CVS Financial Approval Signature If checked, send a copy to Inventory Information purposes for AP. ECR, Logistics, & DSD. CM or FMM Requesting Supplier be setup. Supplier signs and dates. CM signs and dates. DMM signs and dates. Location where merchandise will be shipped from by the supplier The address to return merchandise from the store via Carolina Reclamation. If product ships from multi-locations, utilize Address 2 Required to identify back haul program availability from “Ship From Address” listed above. Is the cost of the freight removed from the price? CVS Supplier Form Ver 3.doc 05/29/2007 JMC 7 of 7