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Supplier Classification Form

Are you a New Supplier or is this Request for a Change of an Existing Supplier Record?*

New supplier
Change request
Address Change
Bank Change
Name Change
Other

  Supplier Information

Supplier Name*
Address*
Address Line2
City*
State/Province
Zip/Mailing Code*
Country*
Telephone*
  
Fax Number
Supplier Remitance Notification E-mail*
(contact for Payment Notice)
Payment Currency
Bank Name
Account Name
Payment Type*
Email Bank Contact
Checking/Lockbox
Bank Contact Name
ACH/ABA Routing #
Bank Phone
Bank Account#
Account Type
(Checking/Savings)
IBAN
SWIFT-BICODE

  Supplier Contact Information

Name*
Phone*
Email*
Position/Job Title*

(US Suppliers)
Supplier Certifies That It Is A:

  • Large Business
  • Small Business
  • Small Disadvantaged Business

(US Suppliers)
Business Type

Corporation Individual
Partnership Trust/Estate
Limited Liability Government Agency
None  

(US Suppliers)
Business Category

Woman Owned Govt/Tax
Manufacturer Freight
Distributor Service
None  

US Federal Tax Identification Number

or

US Social Security Number

Are You a US Minority Business?

Yes
No
MBE Number:
MBE Expiration Date:

If Yes, Check Any That Apply

African American
Asian American
Hispanic American
Native American Indian
Women-owned
None of the above

Additional Information (As Required)

DUNS Number
VAT Number
Business Registration Number

Please provide a brief description of the suppliers products that Sensata will purchase:*

Example: Direct material, Indirect material, Equipment, IT License or Software, Service (consulting or other)

If you are a Supplier of Direct Material or Goods containing Metals, please complete the section below:

Yes, (certifies that Supplier complies with the AIAG Conflict Metals Requirement or that Metals are not contained in any
products shipped.)
No, (response requires Supplier to complete the Conflicts Supplier Minerals Questionnaire per referenced link which must be
sent with this form.)

If you are a Supplier of Direct Material or Goods, are you C-TPAT certified?

Yes
No
Note: If supplier participates in other US Customs Trade Partnership against Terrorism programs or enters a “No” response, they are required to complete the C-TPAT Supplier Profile Questionnaire link at the time of sending this form.

Addtional Certification Required for Supplier of Direct Materials

CHECK ALL THAT APPLY
ISO Certification
ISO/TS 16949 Certification
ISO 14001 Certification

Sensata purchase location*
Please choose at least one location
The Americas Europe Asia Pacific
 Attleboro, MA / Cambridge, MD
 Huntington, IN
 Phoenix, AZ USA
 Bloomington, MN USA
 Springfield, TN USA
 White Bear Lakes, MN USA
 Newall, OH USA

 Aguascalientes, MX,
 Matamoros, MX
 Mexicali, MX

 Dominican Republic

 Brazil

 Ireland (Antrim)

 Belgium (Olen)

 Germany (Olching, Altomunster)

 Germany (Berlin)

 Bulgaria (Botevgrad, Plovdiv)

 Poland (Bydgoszcz)

 Nederland (Hengelo)

 Baoying, China
 Changzhou, China
 Shanghai, China

Japan

Jincheon, Korea
 Cheonan, Korea

 Malaysia

Sensata Employee Name* What is this?This is the name of the Sensata employee or buyer requesting the supplier set up or change.
Sensata Employee Email

Note: By submitting this form, Supplier verifies all information is accurate and agrees to Sensata's standard terms and conditions as accessed via the following link https://www.sensata.com/resources/terms-conditions.

Authorized supplier representative verifies that the information being submitted is accurate.


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