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Peace River Coal Supplier Application Form

Peace River Coal is always interested in forging upon new relationships with suppliers. To be considered as a Peace River Coal supplier/contractor/consultant, please complete the following form and submit for consideration. We will be in contact with all suitable applicants as soon as possible.

Note: This form must be completed in full to be considered.

Corporate Detail

Company Legal Name:

Company /
Corporation Registration Number:

Physical Address:

Province/State:
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Postal/Zip Code:


Check if same as physical address:

Mailing Address:

Province/State:
Please select... Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon
Postal/Zip Code:


Company Website:


Primary Contact:

Contact Title:

Telephone Number:

Cellular Phone Number:

Fax Number:


Email:

Verify Email:


Year Company was Founded:

Number of full-time employees:

Supplies

Business Type:
Supplier
Manufacturer
Contractor
Consultant
Other (please specify):

Description of Products/Services:

(up to 500 characters)

References

Provide 3 references (company name, contact name, and telephone number required):

Reference 1
Company Name:

Contact Name:

Telephone Number:


Reference 2
Company Name:

Contact Name:

Telephone Number:


Reference 3
Company Name:

Contact Name:

Telephone Number:

• This form is to be completed by all vendors seeking registration as an approved Peace River Coal supplier.
• The form must be completed in full to be considered.
• Peace River Coal reserves the right to accept or reject any application without obligation of explanation to the applicant.

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