Windstream Quoting Tool (WIN-QT)
Supplier Information Request Form
To complete the form, please fill in all the fields marked with an asterisk (*) and an 'I' icon. These fields are mandatory and cannot be left blank. The 'I' icon provides you with more details about the purpose and format of each field. You can hover over the icon to see the information. Thank you for your cooperation.
* Indicates required field
*Legal Company Name
:
*Main Phone Number
:
(999-999-9999)
Ext:
*Street Address or PO Box:
*City:
*State/Province:
Select State
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
ALBERTA
BRITISH COLUMBIA
MANITOBA
NEW BRUNSWICK
NEWFOUNDLAND AND LABRADOR
NOVA SCOTIA
ONTARIO
PRINCE EDWARD ISLAND
QUEBEC
SASKATCHEWAN
*Zip:
*Federal Tax ID Number:
Business Owner/Requester or Sponsor
:
Small Business:
Yes
No
Woman-Owned Business:
Yes
No
Currently Certified MBE, MWBE, or DVBE:
Yes
No
Minority-Owned Business:
Yes
No
Second Tier Minority:
Yes
No
Veteran-Owned Business:
Yes
No
Please Note:
Windstream values diversity and inclusion among its suppliers. If your company qualifies as a Minority, Women, Disabled, Veteran, or Business Enterprise (M/W/DV/BE) under any of the classifications we recognize, please register with Supplier.io. They may ask you to provide certification from certain agencies to verify your status.
*Master Agreement with Windstream
:
Yes
No
*Non Disclosure Agreement:
(Is Required)
Yes
No
Quit SIRF