SUPPLIER Application

If you want to become a Medallion Instrumentation Systems supplier, please fill out the application below. It will only take about 10 minutes to fill out this form. Once received, we will forward it to the appropriate Purchasing Manager.

* required information
* First Name
* Last Name
* Company
* Email
* Phone
* Fax

Supplier Guidelines Agreement

By clicking the button below you acknowledge that you have read and agree to follow the Supplier Guidelines unless stated in writing otherwise to Medallion Purchasing Department.
* I Agree

*Web Site Address
*Position/Title
*Street Address
*State/Province
*Country

Company Profile

*Global Sales (Last 12 Months)	(in USD)
*Number of Employees
List your three main customers and the share they represent in your total business (in %).
*Customer		*Location
*Business Share (%)
*Customer		*Location
*Business Share (%)
*Customer		*Location
*Business Share (%)
*What is the share of your sales dedicated to the automotive industry (in %)?

Quality

What is your status regarding?:
*Quality System ISO/TS 16949: Yes No	*VDA6.1: Yes No
*QS 9000: Yes No	*EAQF '94: Yes No
* Other:

Motivation

Please briefly explain why you want to become a Medallion supplier.

Medallion Terms and Conditions