Company Information:
Company:
Address:
City:
Zip:
Country:
State:
Phone:
Fax:
Email:
Person/Corporation Code
- Choose One -
1 - Individual, Non-US:
2 - Corp entity, Non-US:
C - Corp Entity, US:
P - Individual, US:
Other
Supplier Classification
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Class A (Custom Design):
Class B (Distributor):
Class C (Consultant):
Other
Prefered Currency
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USD
GBP
EUR
SGD
Other
DUNS:
Tax ID:
Business Category:
Check all that apply:
Small Business
SDB
WOSB
Hubz
VOSB
SDVOSB
N/A
Would your organization accept Illumina's standard T's&C's
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Yes
No
Undecided
Type:
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Product
Service
Area:
- Choose One -
Production
Non-Production
Product Category
- Choose One -
Engineering Services and Equipment
Facilities
Logistics
Sales and Marketing
Legal
Other Services
Computing
Chemical,Reagents,Biologics
Contract Manufacturing
Optics,Cameras,lasers
Substrates
Fluidics
Mechanical
Product Description
Quality Systems
Check all that Apply
ISO-9000
ISO-13485
FDA Approved
Please briefly describe your quality system
In 1 page or less, please tell us the benefits that a partnership would bring to Illumina
Sales Contact Information
First Name:
Last Name:
Title:
Phone Number:
Email:
SUBMIT
Thank you very much for your interest in becoming an Illumina supplier.
We’ll review your submission and get back to you as soon as possible.