B2B Project Request
VWR
Requestor
Requestor e-Mail
Current Date
Region
Please select
East
Central
West
Canada
Mexico
Puerto Rico
Segment
Please Select One
Pharma
Production Tech
E&MR
Biotech
HealthCare
Industrial
SciEd
BioExpress
Canada
Urgent
VWR Basic Data
Customer Company Name
Customer consortium (E&I, IUC, BIO, etc)? Please indicated which Consortium
Owner
Sales Rep
Sales Rep's Phone #
Sales Rep's e-Mail
Owner
Regional Manager (RM)
Regional Manger's Phone #
Regional Manger's e-Mail
Pricing Coordinator
Pricing Coordinator's Phone #
Onsite (VWR Employee)
Onsite's Phone #
Onsite's e-Mail
Customer Contact Name
Customer Contact Phone #
Customer's Contact e-Mail
Marketplace /
Application Contact Name
Marketplace /
Application Phone #
Marketplace /
Application e-Mail
Current Account Status
New Business?
Yes
Annual Sales
For example: 1000000 (enter numeric monetary values only)
Current Ordering Method?
Fax
e-Mail
EDI / XML
VWR.com
Current Billing Method?
Invoice
C-Bill
EDI / XML
Increased Revenue
B2B Application (GHX, Oracle, SciQuest, etc.)
- please select -
Accuprice
Accuprice / Intalere
AMS
Ariba
Ashokkumar Tamizhmani
Axiom
B-Pack
BASWARE
Bellweather
Bernd
Bioprocure
Buyer Quest Inc.
Carenet
CGI Advantage
Comed
Concur
COUPA
Crossinx
Deltek Costpoint
Diversity Supplier
Dynamix AX
EDI
Enterprise
ePS
eRequestor
ESM
Expense Watch
Fullstep
GEP
GHX
great plains
GSS
Homegrown
Hubwoo
ibuy
IBX
Intalere
Intertrade
Jaggaer
Lab Cloud
Maximo
Mercateo
Microsoft
MUNIS
Netsuite
Nexus
OB10
OCI
Open Markets
OpenText
Oracle
Other
Paramount Workplace
PConnect
People Soft
Perfect Commerce
Periscope
Pnet
Point Purchasing
Pool4Tool
Prendio
PROACTIS
Procurify
Prodigo
ReQlogic
Sage 100
SAP
SciQuest
Seeburger
SicommNet
SimpleSystem
Sonepar
SpendMap
SPS Commerce
SRM
Sterling
Sterling Integration
Summus
Synertrade
Tasko
Taula
test
Tradeshift / IBX
Tungsten
Unimarket
Veenion
Verascape
Vinimaya
Wallmedien/Meplato
Workday
Workplace
WUCATO
Zageno
A.E.R.S
Please Select One
Acquire
Expand
Retain
Service
Account Status IDs
please select at least one!
GKA ID
enter up to a 3 digit GKA numeric value
Customer ID
enter an alpha-numeric value up to 10 digits (CAPs for alpha chars)
SAP SoldTo)
enter an 8 to 10 digit numeric value… whatever that length is (without leading 0000’s)
New Customer - No existing SAP accounts -- for a totally new customer.
Contract Related Questions
Are all contracts signed and in place for this project?
Yes
Contract Status
Blank
Current
Fixed Date
Parent Contract
Blank
One Parent Contract
More than one parent contract
Local Contracts? If YES, how many?
Rebates on Contract
Yes
Rebates on Contract? If YES, how many?
Net Item / Prices on Contract?
Yes
Net item / Prices on Contract, If YES, schedule update?
Are there any cost plus adjustments?
Yes
Do we stock special inventory (TX, SC, other)?
Yes
Comments?
File?
Mandatory Fields