fivetran.coupahost.com
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54.244.45.207
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URL:
https://fivetran.coupahost.com/enter_supplier_information/ebd63beb462bd92b0e1bdc3d2b6d3149a5d90b61
Submission: On July 30 via api from IE — Scanned from DE
Submission: On July 30 via api from IE — Scanned from DE
Form analysis 1 forms found in the DOM
POST /update_supplier_information/ebd63beb462bd92b0e1bdc3d2b6d3149a5d90b61
<form editable="true" id="easy_form_response_form" class="easy_form_response_form guided_experience" enctype="multipart/form-data" action="/update_supplier_information/ebd63beb462bd92b0e1bdc3d2b6d3149a5d90b61" accept-charset="UTF-8" method="post">
<input name="utf8" type="hidden" value="✓" autocomplete="off"><input type="hidden" name="_method" value="patch" autocomplete="off"><input type="hidden" name="authenticity_token"
value="P6Q/hSHWLwTSR7ytickMTCD4fZLUyc5D1Z4f2LSPt6hD+6ZVmg52x23NKREVGnZYPpqylbbnRGVFY+ssNp7nzw==" autocomplete="off">
<div class="form_response form_response_form">
<div class="web_form_header" id="easy_form_response_16487_form">
<script src="/assets/easy_form_helper-f681d198bbce50f60ed1aa576a00028ecc26113b2e6aa05ca40ad0cad7a3cb19.js"></script>
<input type="hidden" name="form_action" id="easy_form_response_action" value="save" autocomplete="off">
<input type="hidden" name="internal_update" id="internal_update" value="false" autocomplete="off">
<input type="hidden" name="upstream_easy_form_response_id" id="upstream_easy_form_response_id" autocomplete="off">
<input type="hidden" name="clicked_easy_form_response_id" id="clicked_easy_form_response_id" value="16487" autocomplete="off">
<div class="form_element inline wrapper_vertical"><label class="group_label" for="Maples_Group_">Supplier Information</label><span class="data">Maples Group</span></div>
<input data-editable="true" value="90" hidden_by_condition="false" autocomplete="off" type="hidden" name="easy_form_response[easy_form_id]" id="easy_form_response_easy_form_id"><input data-editable="true" value="16487"
hidden_by_condition="false" autocomplete="off" type="hidden" name="easy_form_response[easy_form_response_id]" id="easy_form_response_easy_form_response_id">
<div class="form_element wrapper_vertical" id="header_easy_form_widget_1">
<div class="header">
<h2>Basic Supplier Information</h2>
</div>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="name"><label class="group_label" for="easy_form_response_name"><span class="required" aria-hidden="true">*</span>Company Name</label><input data-editable="true" subject="Maples Group"
aria-required="true" aria-invalid="false" aria-describedby="easy_form_response_name_err name_hint" value="Maples Group" type="text" name="easy_form_response[name]" id="easy_form_response_name"></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="display_name"><label class="group_label" for="easy_form_response_display_name">Doing Business As</label><input data-editable="true" subject="Maples Group" aria-required="false" aria-invalid="false"
aria-describedby="easy_form_response_display_name_err display_name_hint" value="Maples Group" type="text" name="easy_form_response[display_name]" id="easy_form_response_display_name"></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_multi_field_widget"><label class="group_label"></label>
<div class="child_widgets child_easy_form_widget_4 child_response s-supplier_information s-edit" id="child_widget_649">
<div class="form_element s-child_widget s-supplier_information_contact s-primary_contact wrapper_multi_field_widget" id="child_easy_form_response_16488">
<h3 class="group_label widget_header"><span class="required" aria-hidden="true">*</span><span>Primary Contact</span></h3>
<div class="multi_field_widget">
<div class="child_widget "><input easy_form_id="40" easy_form_response_id="16488" validate="false" hidden_by_condition="false" data-editable="true" value="40" autocomplete="off" type="hidden"
name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][easy_form_id]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_easy_form_id"><input easy_form_id="40" easy_form_response_id="16488" validate="false" hidden_by_condition="false"
data-editable="true" value="16488" autocomplete="off" type="hidden" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][easy_form_response_id]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_easy_form_response_id">
<div class="form_element wrapper_vertical" id="name_given" data-conditional-child-response="16488"><label class="group_label"
for="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_name_given">First Name</label><input easy_form_id="40" easy_form_response_id="16488" validate="false" data-editable="true"
subject="#<SupplierInformationContact:0x00007f347782c7a8>" aria-required="false" value="Chloe" type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][name_given]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_name_given"></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="name_family" data-conditional-child-response="16488"><label class="group_label"
for="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_name_family">Last Name</label><input easy_form_id="40" easy_form_response_id="16488" validate="false" data-editable="true"
subject="#<SupplierInformationContact:0x00007f347782c7a8>" aria-required="false" value="Burke" type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][name_family]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_name_family"></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="email" data-conditional-child-response="16488"><label class="group_label" for="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_email">Email
address</label><input easy_form_id="40" easy_form_response_id="16488" validate="false" data-editable="true" subject="#<SupplierInformationContact:0x00007f347782c7a8>" aria-required="false"
value="dublinaccountsenquiries@maples.com" type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][email]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_email"><span>
</span><i class="simpletooltip" title="must be valid email"><img class="icon_button sprite-info" alt="" title="" src="/assets/blank-47043e4823a6c21a8881de789b4185355330b5804629d23f6b43dd93f5265292.gif"></i></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="phone_work" data-conditional-child-response="16488"><label class="group_label"
for="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_phone_work">Work Phone</label>
<div class="phone-field" id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_phone_field">
<select name="" id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_toggle">
<option selected="selected" value="domestic">US/Canada</option>
<option value="intl">Other</option>
</select>
<span id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_domestic" class="domestic ">
<input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_work]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work" size="18" object_class_name="Module::F2065300" attribute_name="phone_work">
<div class="hint" style="margin-left:10em;">650-555-1212</div>
</span>
<div id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_intl" class="intl " style="display: none;">
<table>
<tbody>
<tr>
<td class="country_code_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_work][country_code]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_country_code" size="4" disabled="" object_class_name="Module::F2065300" attribute_name="phone_work"></td>
<td class="area_code_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_work][area_code]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_area_code" size="5" disabled="" object_class_name="Module::F2065300" attribute_name="phone_work"></td>
<td class="number_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_work][number]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_number" size="9" disabled="" object_class_name="Module::F2065300" attribute_name="phone_work"></td>
<td class="extension_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_work][extension]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_extension" size="7" disabled="" object_class_name="Module::F2065300" attribute_name="phone_work"></td>
</tr>
<tr>
<td><span class="hint">Country/Region</span></td>
<td><span class="hint">Area/City</span></td>
<td><span class="hint">Local</span></td>
<td><span class="hint">Extension (optional)</span></td>
</tr>
</tbody>
</table>
</div>
</div>
<script type="text/javascript" nonce="">
$(function() {
window.setTimeout(function() {
update_phone_field($("#easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_work_phone_field"));
}, 100);
});
</script>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="phone_mobile" data-conditional-child-response="16488"><label class="group_label"
for="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_phone_mobile">Mobile Phone</label>
<div class="phone-field" id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_phone_field">
<select name="" id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_toggle">
<option selected="selected" value="domestic">US/Canada</option>
<option value="intl">Other</option>
</select>
<span id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_domestic" class="domestic ">
<input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_mobile]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile" size="18" object_class_name="Module::F2065300" attribute_name="phone_mobile">
<div class="hint" style="margin-left:10em;">650-555-1212</div>
</span>
<div id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_intl" class="intl " style="display: none;">
<table>
<tbody>
<tr>
<td class="country_code_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_mobile][country_code]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_country_code" size="4" disabled="" object_class_name="Module::F2065300" attribute_name="phone_mobile">
</td>
<td class="area_code_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_mobile][area_code]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_area_code" size="5" disabled="" object_class_name="Module::F2065300" attribute_name="phone_mobile"></td>
<td class="number_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_mobile][number]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_number" size="9" disabled="" object_class_name="Module::F2065300" attribute_name="phone_mobile"></td>
<td class="extension_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_mobile][extension]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_extension" size="7" disabled="" object_class_name="Module::F2065300" attribute_name="phone_mobile"></td>
</tr>
<tr>
<td><span class="hint">Country/Region</span></td>
<td><span class="hint">Area/City</span></td>
<td><span class="hint">Local</span></td>
<td><span class="hint">Extension (optional)</span></td>
</tr>
</tbody>
</table>
</div>
</div>
<script type="text/javascript" nonce="">
$(function() {
window.setTimeout(function() {
update_phone_field($("#easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_mobile_phone_field"));
}, 100);
});
</script>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="phone_fax" data-conditional-child-response="16488"><label class="group_label"
for="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488__easy_form_response_phone_fax">Fax</label>
<div class="phone-field" id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_phone_field">
<select name="" id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_toggle">
<option selected="selected" value="domestic">US/Canada</option>
<option value="intl">Other</option>
</select>
<span id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_domestic" class="domestic ">
<input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_fax]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax" size="18" object_class_name="Module::F2065300" attribute_name="phone_fax">
<div class="hint" style="margin-left:10em;">650-555-1212</div>
</span>
<div id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_intl" class="intl " style="display: none;">
<table>
<tbody>
<tr>
<td class="country_code_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_fax][country_code]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_country_code" size="4" disabled="" object_class_name="Module::F2065300" attribute_name="phone_fax"></td>
<td class="area_code_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_fax][area_code]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_area_code" size="5" disabled="" object_class_name="Module::F2065300" attribute_name="phone_fax"></td>
<td class="number_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_fax][number]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_number" size="9" disabled="" object_class_name="Module::F2065300" attribute_name="phone_fax"></td>
<td class="extension_fleld"><input type="text" name="easy_form_response[child_easy_form_widget_4][child_easy_form_responses[16488]][easy_form_response][phone_fax][extension]"
id="easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_extension" size="7" disabled="" object_class_name="Module::F2065300" attribute_name="phone_fax"></td>
</tr>
<tr>
<td><span class="hint">Country/Region</span></td>
<td><span class="hint">Area/City</span></td>
<td><span class="hint">Local</span></td>
<td><span class="hint">Extension (optional)</span></td>
</tr>
</tbody>
</table>
</div>
</div>
<script type="text/javascript" nonce="">
$(function() {
window.setTimeout(function() {
update_phone_field($("#easy_form_response_child_easy_form_widget_4_child_easy_form_responses_16488_easy_form_response_phone_fax_phone_field"));
}, 100);
});
</script>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
</div>
</div>
</div>
</div>
</div>
<div class="form_element wrapper_vertical" id="po_email"><label class="group_label" for="easy_form_response_po_email">PO Email</label><input data-editable="true" subject="Maples Group" aria-required="false" aria-invalid="false"
aria-describedby="easy_form_response_po_email_err po_email_hint" type="text" name="easy_form_response[po_email]" id="easy_form_response_po_email"><span>
</span><i class="simpletooltip" title="must be a valid email address"><img class="icon_button sprite-info" alt="" title="" src="/assets/blank-47043e4823a6c21a8881de789b4185355330b5804629d23f6b43dd93f5265292.gif"></i></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_multi_field_widget"><label class="group_label"></label>
<div class="child_widgets child_easy_form_widget_6 child_response s-supplier_information s-edit" id="child_widget_651">
<div class="form_element s-child_widget s-supplier_information_address s-primary_address wrapper_multi_field_widget" id="child_easy_form_response_16489">
<h3 class="group_label widget_header"><span class="required" aria-hidden="true">*</span><span>Primary Address</span></h3>
<div class="multi_field_widget">
<div class="child_widget "><input easy_form_id="46" easy_form_response_id="16489" validate="false" hidden_by_condition="false" data-editable="true" value="46" autocomplete="off" type="hidden"
name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][easy_form_id]"
id="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_easy_form_id"><input easy_form_id="46" easy_form_response_id="16489" validate="false" hidden_by_condition="false"
data-editable="true" value="16489" autocomplete="off" type="hidden" name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][easy_form_response_id]"
id="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_easy_form_response_id">
<div class="form_element wrapper_vertical" id="purposes" data-conditional-child-response="16489"><label class="group_label"
for="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_purposes">Address Purpose</label>
<link rel="stylesheet" href="/assets/sim_purpose_picker-55d14290fc200d5512fb47ee17858f3083738e068768a150ed7ba8059db2e3c3.css" media="screen">
<input name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][purposes][]" type="hidden" value="" autocomplete="off"><select multiple="multiple"
name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][purposes][]" data-ui-fn="chosen"
data-ui-chosen-options="{"width": "280px", "placeholder_text_multiple": "Select Some Options"}" id="supplier_information_address_purpose_ids" style="display: none;">
<option value="19">Branch</option>
<option value="20">Franchise</option>
<option value="22">HQ</option>
<option value="21">Other Address</option>
<option value="18">Service Center</option>
<option value="17">Warehouse</option>
</select>
<div class="chosen-container chosen-container-multi" style="width: 280px;" title="" id="supplier_information_address_purpose_ids_chosen">
<div class="chosen-choices">
<div class="search-field"><input role="combobox" aria-expanded="false" aria-owns="supplier_information_address_purpose_ids_chosen_results" type="text" value="Select Some Options" class="default" autocomplete="off"
style="width: 165px;" aria-describedby="" aria-label="Select Some Options" aria-autocomplete="list"></div>
</div>
</div>
<span>
<span class="has_hovertip has_detailed_hovertip "><span class="hover_target" tabindex="-1" title="Select a category (or multiple categories) to indicate what this address will be used for."><img aria-hidden="true"
class="icon icon_button sprite-info" alt="" title="" src="/assets/blank-47043e4823a6c21a8881de789b4185355330b5804629d23f6b43dd93f5265292.gif"></span><span class="hovertip detailed_hovertip">Select a category (or multiple
categories) to indicate what this address will be used for.</span></span>
</span>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="region" data-conditional-child-response="16489"><label class="group_label"
for="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_region"><span class="required" aria-hidden="true">*</span>Region</label><span class="region_picker">
<div class="form_element wrapper_vertical"><label class="group_label" for="supplier_information_address_country_id">Country/Region</label><select id="sim_address_region_9f21936914b3884d1d71"
name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][region][country_id]" aria-label="Country/Region">
<option value="2">Afghanistan</option>
<option value="3">Albania</option>
<option value="4">Algeria</option>
<option value="5">American Samoa</option>
<option value="6">Andorra</option>
<option value="7">Angola</option>
<option value="8">Anguilla</option>
<option value="9">Antarctica</option>
<option value="10">Antigua and Barbuda</option>
<option value="11">Argentina</option>
<option value="12">Armenia</option>
<option value="13">Aruba</option>
<option value="14">Australia</option>
<option value="15">Austria</option>
<option value="16">Azerbaijan</option>
<option value="17">Bahamas</option>
<option value="18">Bahrain</option>
<option value="19">Bangladesh</option>
<option value="20">Barbados</option>
<option value="21">Belarus</option>
<option value="22">Belgium</option>
<option value="23">Belize</option>
<option value="24">Benin</option>
<option value="25">Bermuda</option>
<option value="26">Bhutan</option>
<option value="27">Bolivia (Plurinational State of)</option>
<option value="245">Bonaire, Sint Eustatius and Saba</option>
<option value="28">Bosnia and Herzegovina</option>
<option value="29">Botswana</option>
<option value="30">Bouvet Island</option>
<option value="31">Brazil</option>
<option value="32">British Indian Ocean Territory</option>
<option value="33">Brunei Darussalam</option>
<option value="34">Bulgaria</option>
<option value="35">Burkina Faso</option>
<option value="36">Burundi</option>
<option value="40">Cabo Verde</option>
<option value="37">Cambodia</option>
<option value="38">Cameroon</option>
<option value="39">Canada</option>
<option value="41">Cayman Islands</option>
<option value="42">Central African Republic</option>
<option value="43">Chad</option>
<option value="44">Chile</option>
<option value="45">China</option>
<option value="46">Christmas Island</option>
<option value="47">Cocos (Keeling) Islands</option>
<option value="48">Colombia</option>
<option value="49">Comoros</option>
<option value="50">Congo</option>
<option value="246">Congo (Democratic Republic of the)</option>
<option value="51">Cook Islands</option>
<option value="52">Costa Rica</option>
<option value="53">Croatia</option>
<option value="54">Cuba</option>
<option value="247">Curaçao</option>
<option value="55">Cyprus</option>
<option value="56">Czech Republic</option>
<option value="106">Côte d'Ivoire</option>
<option value="58">Denmark</option>
<option value="59">Djibouti</option>
<option value="60">Dominica</option>
<option value="61">Dominican Republic</option>
<option value="63">Ecuador</option>
<option value="64">Egypt</option>
<option value="65">El Salvador</option>
<option value="66">Equatorial Guinea</option>
<option value="248">Eritrea</option>
<option value="67">Estonia</option>
<option value="203">Eswatini</option>
<option value="68">Ethiopia</option>
<option value="69">Falkland Islands (Malvinas)</option>
<option value="70">Faroe Islands</option>
<option value="71">Fiji</option>
<option value="72">Finland</option>
<option value="73">France</option>
<option value="89">French Guiana</option>
<option value="172">French Polynesia</option>
<option value="75">French Southern Territories</option>
<option value="76">Gabon</option>
<option value="77">Gambia</option>
<option value="78">Georgia</option>
<option value="79">Germany</option>
<option value="80">Ghana</option>
<option value="81">Gibraltar</option>
<option value="83">Greece</option>
<option value="84">Greenland</option>
<option value="85">Grenada</option>
<option value="86">Guadeloupe</option>
<option value="87">Guam</option>
<option value="88">Guatemala</option>
<option value="249">Guernsey</option>
<option value="90">Guinea</option>
<option value="91">Guinea-Bissau</option>
<option value="92">Guyana</option>
<option value="93">Haiti</option>
<option value="94">Heard Island and McDonald Islands</option>
<option value="228">Holy See (Vatican City State)</option>
<option value="95">Honduras</option>
<option value="96">Hong Kong</option>
<option value="97">Hungary</option>
<option value="98">Iceland</option>
<option value="99">India</option>
<option value="100">Indonesia</option>
<option value="101">Iran (Islamic Republic of)</option>
<option value="102">Iraq</option>
<option value="103">Ireland</option>
<option value="250">Isle of Man</option>
<option value="104">Israel</option>
<option value="105">Italy</option>
<option value="107">Jamaica</option>
<option value="108">Japan</option>
<option value="251">Jersey</option>
<option value="109">Jordan</option>
<option value="110">Kazakhstan</option>
<option value="111">Kenya</option>
<option value="112">Kiribati</option>
<option value="113">Korea (North - Democratic People's Republic of)</option>
<option value="114">Korea (South - Republic of)</option>
<option value="259">Kosovo</option>
<option value="115">Kuwait</option>
<option value="116">Kyrgyzstan</option>
<option value="117">Lao People's Democratic Republic</option>
<option value="118">Latvia</option>
<option value="119">Lebanon</option>
<option value="120">Lesotho</option>
<option value="121">Liberia</option>
<option value="122">Libya</option>
<option value="123">Liechtenstein</option>
<option value="124">Lithuania</option>
<option value="125">Luxembourg</option>
<option value="126">Macao</option>
<option value="128">Madagascar</option>
<option value="129">Malawi</option>
<option value="130">Malaysia</option>
<option value="131">Maldives</option>
<option value="132">Mali</option>
<option value="133">Malta</option>
<option value="134">Marshall Islands</option>
<option value="135">Martinique</option>
<option value="136">Mauritania</option>
<option value="137">Mauritius</option>
<option value="252">Mayotte</option>
<option value="138">Mexico</option>
<option value="139">Micronesia (Federated States of)</option>
<option value="140">Moldova (Republic of)</option>
<option value="141">Monaco</option>
<option value="142">Mongolia</option>
<option value="240">Montenegro</option>
<option value="143">Montserrat</option>
<option value="144">Morocco</option>
<option value="145">Mozambique</option>
<option value="146">Myanmar</option>
<option value="147">Namibia</option>
<option value="148">Nauru</option>
<option value="149">Nepal</option>
<option value="150">Netherland Antilles</option>
<option value="151">Netherlands</option>
<option value="152">Neutral Zone</option>
<option value="153">New Caledonia</option>
<option value="154">New Zealand</option>
<option value="155">Nicaragua</option>
<option value="156">Niger</option>
<option value="157">Nigeria</option>
<option value="158">Niue</option>
<option value="159">Norfolk Island</option>
<option value="127">North Macedonia</option>
<option value="160">Northern Mariana Islands</option>
<option value="161">Norway</option>
<option value="162">Oman</option>
<option value="163">Pakistan</option>
<option value="164">Palau</option>
<option value="253">Palestine, State of</option>
<option value="165">Panama</option>
<option value="166">Papua New Guinea</option>
<option value="167">Paraguay</option>
<option value="168">Peru</option>
<option value="169">Philippines</option>
<option value="170">Pitcairn</option>
<option value="171">Poland</option>
<option value="173">Portugal</option>
<option value="174">Puerto Rico</option>
<option value="175">Qatar</option>
<option value="177">Romania</option>
<option value="178">Russian Federation</option>
<option value="179">Rwanda</option>
<option value="176">Réunion</option>
<option value="254">Saint Barthélemy</option>
<option value="195">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="198">Saint Kitts and Nevis</option>
<option value="180">Saint Lucia</option>
<option value="255">Saint Martin (French Part)</option>
<option value="196">Saint Pierre and Miquelon</option>
<option value="199">Saint Vincent and the Grenadines</option>
<option value="181">Samoa</option>
<option value="182">San Marino</option>
<option value="197">Sao Tome and Principe</option>
<option value="183">Saudi Arabia</option>
<option value="184">Senegal</option>
<option value="241">Serbia</option>
<option value="185">Seychelles</option>
<option value="186">Sierra Leone</option>
<option value="187">Singapore</option>
<option value="256">Sint Maarten (Dutch Part)</option>
<option value="188">Slovakia</option>
<option value="189">Slovenia</option>
<option value="190">Solomon Islands</option>
<option value="191">Somalia</option>
<option value="192">South Africa</option>
<option value="257">South Georgia and the South Sandwich Islands</option>
<option value="258">South Sudan</option>
<option value="193">Spain</option>
<option value="260">Spain - Canary Islands</option>
<option value="194">Sri Lanka</option>
<option value="200">Sudan</option>
<option value="201">Suriname</option>
<option value="202">Svalbard and Jan Mayen</option>
<option value="204">Sweden</option>
<option value="205">Switzerland</option>
<option value="206">Syrian Arab Republic</option>
<option value="208">Taiwan</option>
<option value="207">Tajikistan</option>
<option value="209">Tanzania, United Republic of</option>
<option value="210">Thailand</option>
<option value="62">Timor-Leste</option>
<option value="211">Togo</option>
<option value="212">Tokelau</option>
<option value="213">Tonga</option>
<option value="214">Trinidad and Tobago</option>
<option value="215">Tunisia</option>
<option value="217">Turkmenistan</option>
<option value="218">Turks and Caicos Islands</option>
<option value="219">Tuvalu</option>
<option value="216">Türkiye</option>
<option value="220">Uganda</option>
<option value="221">Ukraine</option>
<option value="222">United Arab Emirates</option>
<option value="82">United Kingdom</option>
<option selected="selected" value="223">United States</option>
<option value="225">United States Minor Outlying Islands</option>
<option value="224">Uruguay</option>
<option value="226">Uzbekistan</option>
<option value="227">Vanuatu</option>
<option value="229">Venezuela (Bolivarian Republic of)</option>
<option value="230">Viet Nam</option>
<option value="231">Virgin Islands (British)</option>
<option value="232">Virgin Islands (U.S.)</option>
<option value="233">Wallis and Futuna</option>
<option value="234">Western Sahara</option>
<option value="235">Yemen</option>
<option value="237">Zaire</option>
<option value="238">Zambia</option>
<option value="239">Zimbabwe</option>
<option value="244">Åland Islands</option>
<option value="-1">Not Applicable</option>
</select></div>
<div class="form_element wrapper_vertical"><label class="group_label" for="supplier_information_address_state_region">State Region</label>
<script src="/assets/state_iso_code_update-12c29a4cbac7b9a5347b916f389b200106891091f1fb3e57d1751425bd144714.js"></script>
<link rel="stylesheet" href="/assets/address_subdivision_picker-59c11ac3e713a35ac86cf1c9020526c7ca21b3bdc7d61bad278395a87a59bd48.css" media="screen">
<div class="subdivision_picker" id="address_subdivision_98f0670bd126a0f38ed3">
<input name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][region][state_region]" type="text" style="display: none;">
<label class="hidden">State Region</label>
<select name="subdivision_code" class="subdivision_code" data-associated-country-selector-id="#sim_address_region_9f21936914b3884d1d71" data-associated-state-iso-id="#sim_address_iso_83b30c8336ccfa13aa3b"
style="display: none;">
<option value="" label=" "></option>
<option value="AK" state-iso-code="US-AK">Alaska - AK</option>
<option value="AL" state-iso-code="US-AL">Alabama - AL</option>
<option value="AR" state-iso-code="US-AR">Arkansas - AR</option>
<option value="AZ" state-iso-code="US-AZ">Arizona - AZ</option>
<option value="CA" state-iso-code="US-CA">California - CA</option>
<option value="CO" state-iso-code="US-CO">Colorado - CO</option>
<option value="CT" state-iso-code="US-CT">Connecticut - CT</option>
<option value="DC" state-iso-code="US-DC">Washington DC - DC</option>
<option value="DE" state-iso-code="US-DE">Delaware - DE</option>
<option value="FL" state-iso-code="US-FL">Florida - FL</option>
<option value="GA" state-iso-code="US-GA">Georgia - GA</option>
<option value="HI" state-iso-code="US-HI">Hawaii - HI</option>
<option value="IA" state-iso-code="US-IA">Iowa - IA</option>
<option value="ID" state-iso-code="US-ID">Idaho - ID</option>
<option value="IL" state-iso-code="US-IL">Illinois - IL</option>
<option value="IN" state-iso-code="US-IN">Indiana - IN</option>
<option value="KS" state-iso-code="US-KS">Kansas - KS</option>
<option value="KY" state-iso-code="US-KY">Kentucky - KY</option>
<option value="LA" state-iso-code="US-LA">Louisiana - LA</option>
<option value="MA" state-iso-code="US-MA">Massachusetts - MA</option>
<option value="MD" state-iso-code="US-MD">Maryland - MD</option>
<option value="ME" state-iso-code="US-ME">Maine - ME</option>
<option value="MI" state-iso-code="US-MI">Michigan - MI</option>
<option value="MN" state-iso-code="US-MN">Minnesota - MN</option>
<option value="MO" state-iso-code="US-MO">Missouri - MO</option>
<option value="MS" state-iso-code="US-MS">Mississippi - MS</option>
<option value="MT" state-iso-code="US-MT">Montana - MT</option>
<option value="NC" state-iso-code="US-NC">North Carolina - NC</option>
<option value="ND" state-iso-code="US-ND">North Dakota - ND</option>
<option value="NE" state-iso-code="US-NE">Nebraska - NE</option>
<option value="NH" state-iso-code="US-NH">New Hampshire - NH</option>
<option value="NJ" state-iso-code="US-NJ">New Jersey - NJ</option>
<option value="NM" state-iso-code="US-NM">New Mexico - NM</option>
<option value="NV" state-iso-code="US-NV">Nevada - NV</option>
<option value="NY" state-iso-code="US-NY">New York - NY</option>
<option value="OH" state-iso-code="US-OH">Ohio - OH</option>
<option value="OK" state-iso-code="US-OK">Oklahoma - OK</option>
<option value="OR" state-iso-code="US-OR">Oregon - OR</option>
<option value="PA" state-iso-code="US-PA">Pennsylvania - PA</option>
<option value="RI" state-iso-code="US-RI">Rhode Island - RI</option>
<option value="SC" state-iso-code="US-SC">South Carolina - SC</option>
<option value="SD" state-iso-code="US-SD">South Dakota - SD</option>
<option value="TN" state-iso-code="US-TN">Tennessee - TN</option>
<option value="TX" state-iso-code="US-TX">Texas - TX</option>
<option value="UT" state-iso-code="US-UT">Utah - UT</option>
<option value="VA" state-iso-code="US-VA">Virginia - VA</option>
<option value="VT" state-iso-code="US-VT">Vermont - VT</option>
<option value="WA" state-iso-code="US-WA">Washington - WA</option>
<option value="WI" state-iso-code="US-WI">Wisconsin - WI</option>
<option value="WV" state-iso-code="US-WV">West Virginia - WV</option>
<option value="WY" state-iso-code="US-WY">Wyoming - WY</option>
<option value="AA" state-iso-code="US-AA">Armed Forces Americas - AA</option>
<option value="AE" state-iso-code="US-AE">Armed Forces Europe - AE</option>
<option value="AP" state-iso-code="US-AP">Armed Forces Pacific - AP</option>
<option value="AS" state-iso-code="US-AS">American Samoa - AS</option>
<option value="GU" state-iso-code="US-GU">Guam - GU</option>
<option value="MP" state-iso-code="US-MP">Northern Mariana Islands - MP</option>
<option value="PR" state-iso-code="US-PR">Puerto Rico - PR</option>
<option value="UM" state-iso-code="US-UM">U.S. Outlying Islands - UM</option>
<option value="VI" state-iso-code="US-VI">U.S. Virgin Islands - VI</option>
</select>
<div class="chosen-container chosen-container-single" style="width: 376px;" title=""><span id="undefined_hint" style="display: none">"Use space or down arrow key to open the
combobox."</span><a class="chosen-single chosen-default" tabindex="0"><span>None</span><div><b></b></div></a></div>
<div class="invalid_subdivision_warning"><span class="has_hovertip has_detailed_hovertip "><span class="hover_target" tabindex="-1" title="Choose the correct State or Region unless you need to keep the current value."><img
aria-hidden="true" class="icon icon_button sprite-info" alt="" title="" src="/assets/blank-47043e4823a6c21a8881de789b4185355330b5804629d23f6b43dd93f5265292.gif"></span><span class="hovertip detailed_hovertip">Choose
the correct State or Region unless you need to keep the current value.</span></span></div>
<div class="subdivision_absent_helper_message" style="display: none;">
<div class="hint">Add N/A if you do not have a state or region</div>
</div>
</div>
</div>
<div class="form_element wrapper_vertical"><span class="group_label label_readonly" object="#<SupplierInformationAddress:0x00007f34788974d0>">State ISO Code</span><input
name="easy_form_response[child_easy_form_widget_6][child_easy_form_responses[16489]][easy_form_response][region][state_iso_code]" label="State ISO Code" id="sim_address_iso_83b30c8336ccfa13aa3b" readonly="readonly"
type="text"></div>
</span>
</div>
<script>
//<![CDATA[
$(function() {});
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</script>
<div class="form_element wrapper_vertical" id="address_name" data-conditional-child-response="16489"><label class="group_label"
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id="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_address_name"></div>
<script>
//<![CDATA[
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<div class="form_element wrapper_vertical" id="street_address" data-conditional-child-response="16489"><label class="group_label"
for="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_street_address"><span class="required" aria-hidden="true">*</span>Street Address</label><input easy_form_id="46"
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<script>
//<![CDATA[
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<div class="form_element wrapper_vertical" id="street_address2" data-conditional-child-response="16489"><label class="group_label"
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<script>
//<![CDATA[
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<div class="form_element wrapper_vertical" id="street_address3" data-conditional-child-response="16489"><label class="group_label"
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<script>
//<![CDATA[
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<div class="form_element wrapper_vertical" id="street_address4" data-conditional-child-response="16489"><label class="group_label"
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data-editable="true" subject="#<SupplierInformationAddress:0x00007f34780a1be0>" aria-required="false" type="text"
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<script>
//<![CDATA[
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<div class="form_element wrapper_vertical" id="city" data-conditional-child-response="16489"><label class="group_label" for="easy_form_response_child_easy_form_widget_6_child_easy_form_responses_16489__easy_form_response_city"><span
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</div>
<script>
//<![CDATA[
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<div class="form_element wrapper_vertical" id="postal_code" data-conditional-child-response="16489"><label class="group_label"
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<script>
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<div class="form_element wrapper_vertical" id="location_code" data-conditional-child-response="16489"><label class="group_label"
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<script>
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</div>
</div>
</div>
</div>
</div>
<div class="form_element wrapper_vertical" id="header_easy_form_widget_7">
<div class="header">
<h2>Customer Support Contact Information</h2>
</div>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
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<div class="form_element wrapper_vertical" id="is_your_organization_us_based_" data-conditional-widget-id="656" data-conditional-widget-type="RadioGroupEasyFormWidget" role="radiogroup"
aria-labelledby="aria_is_your_organization_us_based__656_label"><label class="group_label" id="aria_is_your_organization_us_based__656_label" for="easy_form_response_is_your_organization_us_based_"><span class="required"
aria-hidden="true">*</span>Is your organization US-based?</label><label class="text_label"><input type="radio" name="easy_form_response[is_your_organization_us_based_]" id="easy_form_response_is_your_organization_us_based__Yes"
value="Yes" data-editable="true" subject="Maples Group" aria-required="true" aria-invalid="false" aria-describedby="easy_form_response_is_your_organization_us_based__err is_your_organization_us_based__hint"> Yes</label><label
class="text_label"><input type="radio" name="easy_form_response[is_your_organization_us_based_]" id="easy_form_response_is_your_organization_us_based__No" value="No" data-editable="true" subject="Maples Group" aria-required="true"
aria-invalid="false" aria-describedby="easy_form_response_is_your_organization_us_based__err is_your_organization_us_based__hint"> No</label></div>
<script>
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$(function() {});
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<div class="form_element wrapper_vertical hidden" id="tax_classification" data-easy-form="conditional" data-conditional-parent="656" data-conditional-value="Yes" data-conditional-visibility="hidden"><label class="group_label"
for="easy_form_response_tax_classification">Tax Classification</label><input data-editable="true" subject="Maples Group" aria-required="false" aria-invalid="false"
aria-describedby="easy_form_response_tax_classification_err tax_classification_hint" value="" size="50" maxlength="255" type="text" name="easy_form_response[tax_classification]" id="easy_form_response_tax_classification"
disabled="disabled"></div>
<script>
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$(function() {});
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<div class="form_element wrapper_multi_field_widget hidden" data-easy-form="conditional" data-conditional-parent="656" data-conditional-value="Yes" data-conditional-visibility="hidden" data-subform="1"><label class="group_label"></label>
<div class="child_widgets child_easy_form_widget_10 child_response s-supplier_information s-edit" id="child_widget_658">
<div class="form_element s-child_widget s-supplier_information_artifact s-sim_federal_tax_form_artifacts wrapper_multi_field_widget" id="child_easy_form_response_16490">
<h3 class="group_label widget_header"><span>Federal Tax Form</span></h3>
<div class="multi_field_widget">
<div class="child_widget "><input easy_form_id="1" easy_form_response_id="16490" validate="false" hidden_by_condition="false" data-editable="true" value="1" autocomplete="off" type="hidden"
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<div class="form_element wrapper_vertical" id="artifact_meta_type" data-conditional-child-response="16490"><label class="group_label"
for="easy_form_response_child_easy_form_widget_10_child_easy_form_responses_16490__easy_form_response_artifact_meta_type">Type</label><select data-editable="true" class=" managed-data"
name="easy_form_response[child_easy_form_widget_10][child_easy_form_responses[16490]][easy_form_response][artifact_meta_type]"
id="easy_form_response_child_easy_form_widget_10_child_easy_form_responses_16490__easy_form_response_artifact_meta_type" disabled="disabled">
<option value="" label=" "></option>
<option value="w8">W8</option>
<option value="w9">W9</option>
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<div class="form_element wrapper_vertical" id="attachments" data-conditional-child-response="16490" role="group"><label class="group_label"
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<div class="attachments attachified attachments_33967159">
<div class="attachments-add" data-url="/attachments">
<div class="toggle-links"> Add <ul class="horizontal" aria-labelledby="attachments_ul_97830087">
<li>
<a aria-label="Add File Attachment" class="file-attachment" href="javascript:void(0);">File</a>
</li>
</ul>
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<div class="fields flash_hidden" id="attachment_pop_in_75832794" tabindex="-1"><input type="hidden" name="unique_class_name" value="attachments_33967159">
<input type="hidden" name="attachment[linked_to]" id="attachment_linked_to_75832794" value="" autocomplete="off" disabled="disabled">
<input type="hidden" name="field_root_name" id="field_root_name_75832794" value="easy_form_response[child_easy_form_widget_10][child_easy_form_responses[16490]][easy_form_response][attachments_attributes][]" autocomplete="off"
disabled="disabled">
<div class="right_section">
<div class="file-attachment toggle flash_hidden">
<div class="qq-upload-button-selector qq-upload-button button blue" id="easy_form_response_child_easy_form_widget_10_child_easy_form_responses_16490_easy_form_response_attachments_attributes_attachment"
style="position: relative; overflow: hidden; direction: ltr;">
<span>Browse</span>
<input qq-button-id="4525b696-cb1e-40b4-b19f-e77aa8e5be42" title="file input" multiple="" type="file" name="attachment[file]" tabindex="0"
style="position: absolute; width: 100%; right: 0px; top: 0px; font-family: Arial; font-size: 118px; margin: 0px; padding: 0px; cursor: pointer; opacity: 0; height: 100%;">
</div>
<div class="js-fine-uploader fine-uploadified" data-linked-to="" data-size-validation-message="File size cannot exceed " data-size-validation="false" data-url="/attachments" data-with-fields-in=".fields">
<div class="qq-uploader-selector qq-uploader">
<span class="js-dropText">
<span class="dropIcon" qq-drop-area-text="Drop files here">
<i class="fa fa-fw fa-cloud-upload"></i>
</span>
</span>
<div class="qq-total-progress-bar-container-selector qq-total-progress-bar-container qq-hide">
<div aria-valuemax="100" aria-valuemin="0" aria-valuenow="0" class="qq-total-progress-bar-selector qq-progress-bar qq-total-progress-bar" role="progressbar"></div>
</div>
<div class="qq-upload-drop-area-selector qq-upload-drop-area" qq-hide-dropzone="" style="display: none;">
<span class="qq-upload-drop-area-text-selector"></span>
</div>
<span class="qq-drop-processing-selector qq-drop-processing qq-hide">
<span>Processing dropped files...</span>
<span class="qq-drop-processing-spinner-selector qq-drop-processing-spinner spinner"></span>
</span>
<ul aria-live="polite" aria-relevant="additions removals" class="qq-upload-list-selector qq-upload-list" aria-labelledby="attachments_ul_97830087"></ul>
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</div>
</div>
<input autocomplete="off" type="hidden" value="Supplier" name="attachment[intent]" id="attachment_intent" disabled="disabled">
<a class="button left small blue s-add-attachment" data-disabled-text="Adding..." tabindex="0">
<span>Add</span>
</a>
<a class="close_button right" role="button" tabindex="0" title="Close"></a>
</div>
</div>
</div>
<ul class="attachments-list" aria-labelledby="attachments_ul_97830087">
</ul>
</div>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
</div>
</div>
</div>
</div>
</div>
<div class="form_element wrapper_vertical hidden" id="intl_tax_classification" data-easy-form="conditional" data-conditional-parent="656" data-conditional-value="No" data-conditional-visibility="hidden"><label class="group_label"
for="easy_form_response_intl_tax_classification">International Tax Classification</label><select aria-describedby="easy_form_response_intl_tax_classification_err intl_tax_classification_hint" aria-invalid="false" data-editable="true"
class=" managed-data" name="easy_form_response[intl_tax_classification]" id="easy_form_response_intl_tax_classification" disabled="disabled">
<option value="" label=" "></option>
<option value="Active NFFE">Active NFFE</option>
<option value="Passive NFFE (including trusts)">Passive NFFE (including trusts)</option>
<option value="Exempt beneficial owner">Exempt beneficial owner</option>
<option value="Deemed compliant FFI">Deemed compliant FFI</option>
<option value="Canadian Financial Institution">Canadian Financial Institution</option>
<option value="Other Partner Jurisdiction Financial Institution">Other Partner Jurisdiction Financial Institution</option>
<option value="Participating Foreign Financial Institution">Participating Foreign Financial Institution</option>
<option value="Non Participating Financial Institution">Non Participating Financial Institution</option>
<option value="Specified U.S. Person">Specified U.S. Person</option>
<option value="Not a Specified U.S. Person">Not a Specified U.S. Person</option>
</select></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical hidden" id="international_tax_form" data-easy-form="conditional" data-conditional-parent="656" data-conditional-value="No" data-conditional-visibility="hidden"><label class="group_label"
object="#<Module::F2061380:0x00007f3477554ad0>" for="submittable_attachment_easy_form_widget_response_660">International Tax Form</label><span class="file-field-wrapper"><span class="show" style="display:none;"><span
class="link"><a href="?supplier_view_key=f875906f2c6817f1eddb767302f647081238c9a0">?supplier_view_key=f875906f2c6817f1eddb767302f647081238c9a0</a></span><span class="hint"> (<span
class="change"><a id="660,16487_change" href="javascript:void(0);" data-link-to-function-id="link-3f47938e-4c40-4989-beb2-652f1e2ecce5">Change</a>
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<script>
//<![CDATA[
$(document).on('click', '[data-link-to-function-id=link-0477c96d-c20f-448b-8112-85c2859f5e80]', function() {
var f = $(this).parents('.file-field-wrapper');
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f.find(':input').val(null);
f.find('.show').hide();
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f.find('.no-change').prop('disabled', true);
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</span>)</span></span><span class="edit" role="button" aria-label="Choose"><input type="file" name="submittable_attachment_easy_form_widget_response[660,16487]" id="submittable_attachment_easy_form_widget_response_660_16487"
skip_default_ids="false" allow_method_names_outside_object="false" allow_clear="true" label="International Tax Form" hide_change_link="false" supplier_view_key="f875906f2c6817f1eddb767302f647081238c9a0"
data-submittable-attachment-ajax-upload="true" disabled="disabled"></span></span></div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_multi_field_widget"><label class="group_label"></label>
<div class="child_widgets child_easy_form_widget_13 child_response s-supplier_information s-edit" id="child_widget_661">
<div class="child_widgets_header">
<div class="header"><span class="required"></span>
<h2>Tax Registrations</h2>
</div>
<div class="child_widgets_description">
<p>Use this section to add all your applicable tax registrations.</p>
</div>
<div class="child_widgets_main_actions">
<a class="add_child_widget_button rollover button" data-disable-on-click="true" data-link-to-function-id="link-2dff715e-9ff5-4529-adee-9a9d8e58757d" href="javascript:void(0);"><span>Add Tax Registration</span></a>
<script>
//<![CDATA[
$(document).on('click', '[data-link-to-function-id=link-2dff715e-9ff5-4529-adee-9a9d8e58757d]', function() {
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"child_easy_form_response_id": null,
"allow_csp_remit_to_address_picker_button": null,
"coupa_pay_disabled": false,
"is_add_diversity_widget": false,
"is_add_tax_reg_widget": true,
"is_add_rta_widget": false,
"csp_remit_to_address_picker_supplier_information_url": "/supplier_information/2171/csp_remit_to_address_picker?container=%23child_widget_661+.child_widgets_go_here\u0026create_child_widget_easy_form_response_url=%2Feasy_form_responses%2F16487%2Fcreate_child_widget%3Fis_preview_request%3Dfalse%26object_name%3Deasy_form_response%26widget_id%3D661"
});
return false;
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</script>
</div>
<div class="child_widgets_go_here"></div>
</div>
</div>
</div>
<div class="form_element wrapper_vertical" id="section_break_easy_form_widget_14">
<hr class="section_break_easy_form_widget">
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="header_easy_form_widget_15">
<div class="header">
<h2>Payment Information</h2>
</div>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_vertical" id="descriptive_text_easy_form_widget_16">
<div class="descriptive_text_easy_form_widget">
<p>Coupa Pay <span style="text-decoration:underline;"><strong>requires</strong> </span>Two Factor Authentication Setup on a mobile device using either an authenticator application (i.e., Google Authenticator) or SMS Text
Messaging. Create a Remit To Address with your Banking Details.</p>
</div>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
<div class="form_element wrapper_multi_field_widget"><label class="group_label"></label>
<div class="child_widgets child_easy_form_widget_17 child_response s-supplier_information s-edit" id="child_widget_878">
<div class="child_widgets_header">
<div class="header"><span class="required"></span>
<h2>Remit-To Addresses</h2>
</div>
<div class="child_widgets_description">
<p>Add one or more Remit-To Addresses by either filling out a new Compliant Invoicing Form or choosing an Existing Remit-To Address.</p>
</div>
<div class="child_widgets_main_actions">
<a class="add_child_widget_button rollover button" data-disable-on-click="true" data-link-to-function-id="link-a91b0928-d546-421b-b35c-45cdf72c9bff" href="javascript:void(0);"><span>Add Remit-To</span></a>
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//<![CDATA[
$(document).on('click', '[data-link-to-function-id=link-a91b0928-d546-421b-b35c-45cdf72c9bff]', function() {
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"container": "#child_widget_878 .child_widgets_go_here",
"child_easy_form_response_id": null,
"allow_csp_remit_to_address_picker_button": true,
"coupa_pay_disabled": false,
"is_add_diversity_widget": false,
"is_add_tax_reg_widget": false,
"is_add_rta_widget": true,
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});
return false;
});
//]]>
</script>
</div>
<div class="child_widgets_go_here"></div>
</div>
</div>
</div>
<div class="form_element wrapper_vertical" id="supporting_documentation"><label class="group_label" object="#<Module::F2061380:0x00007f3477554ad0>" for="submittable_attachment_easy_form_widget_response_669">Supporting Documentation</label><span
class="file-field-wrapper"><span class="show" style="display:none;"><span class="link"><a href="?supplier_view_key=c22c4d157cc9831dbc69cb8aecbefaa600c047bb">?supplier_view_key=c22c4d157cc9831dbc69cb8aecbefaa600c047bb</a></span><span
class="hint"> (<span class="change"><a id="669,16487_change" href="javascript:void(0);" data-link-to-function-id="link-e17f0cce-4f04-453d-b19b-56ac9686294e">Change</a>
<script>
//<![CDATA[
$(document).on('click', '[data-link-to-function-id=link-e17f0cce-4f04-453d-b19b-56ac9686294e]', function() {
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f.find('.show').hide();
f.find('.edit').show();
f.find('.no-change').prop('disabled', true);
f.find('.edit > input').prop('disabled', false);;
return false;
});
//]]>
</script>
</span><span class="clear-wrapper">, <input id="hidden_submittable_attachment_easy_form_widget_response_669_16487_clear" disabled="disabled" class="clear" autocomplete="off" type="hidden"
name="submittable_attachment_easy_form_widget_response[669,16487]"><a id="669,16487_clear" href="javascript:void(0);" data-link-to-function-id="link-a3674518-0f58-4432-875f-46bd8c24981c">Clear</a>
<script>
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f.find(':input').val(null);
f.find('.show').hide();
f.find('.edit').show();
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f.find('.edit > input').prop('disabled', false);;
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//]]>
</script>
</span>)</span></span><span class="edit" role="button" aria-label="Choose"><input type="file" name="submittable_attachment_easy_form_widget_response[669,16487]" id="submittable_attachment_easy_form_widget_response_669_16487"
skip_default_ids="false" allow_method_names_outside_object="false" allow_clear="true" label="Supporting Documentation" hide_change_link="false" supplier_view_key="c22c4d157cc9831dbc69cb8aecbefaa600c047bb"
data-submittable-attachment-ajax-upload="true"></span></span>
<div class="hint" id="supporting_documentation_hint">
<p>Please attach a copy of a voided check or bank details on company letterhead.</p>
</div>
</div>
<script>
//<![CDATA[
$(function() {});
//]]>
</script>
</div>
</div>
<br>
<hr>
<div class="page_buttons_right">
<a class="button blue rollover button " id="submit" data-purpose="submit_for_approval_san" data-confirmation="san_submit" href="#"><span>Submit</span></a>
<a id="decline" data-disable-on-click="true" data-purpose="decline" data-san="true" class=" rollover button " href="#"><span>Decline</span></a>
</div>
</form>Text Content
Manage your profile and more with Coupa. Create Your Account Sign Out SIM 2 - Supplier Response v2 Supplier InformationMaples Group BASIC SUPPLIER INFORMATION *Company Name Doing Business As *PRIMARY CONTACT First Name Last Name Email address Work Phone US/Canada Other 650-555-1212 Country/Region Area/City Local Extension (optional) Mobile Phone US/Canada Other 650-555-1212 Country/Region Area/City Local Extension (optional) Fax US/Canada Other 650-555-1212 Country/Region Area/City Local Extension (optional) PO Email *PRIMARY ADDRESS Address Purpose Branch Franchise HQ Other Address Service Center Warehouse Select a category (or multiple categories) to indicate what this address will be used for. *Region Country/RegionAfghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (North - Democratic People's Republic of) Korea (South - Republic of) Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherland Antilles Netherlands Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Spain - Canary Islands Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkmenistan Turks and Caicos Islands Tuvalu Türkiye Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zaire Zambia Zimbabwe Åland Islands Not Applicable State Region State Region Alaska - AKAlabama - ALArkansas - ARArizona - AZCalifornia - CAColorado - COConnecticut - CTWashington DC - DCDelaware - DEFlorida - FLGeorgia - GAHawaii - HIIowa - IAIdaho - IDIllinois - ILIndiana - INKansas - KSKentucky - KYLouisiana - LAMassachusetts - MAMaryland - MDMaine - MEMichigan - MIMinnesota - MNMissouri - MOMississippi - MSMontana - MTNorth Carolina - NCNorth Dakota - NDNebraska - NENew Hampshire - NHNew Jersey - NJNew Mexico - NMNevada - NVNew York - NYOhio - OHOklahoma - OKOregon - ORPennsylvania - PARhode Island - RISouth Carolina - SCSouth Dakota - SDTennessee - TNTexas - TXUtah - UTVirginia - VAVermont - VTWashington - WAWisconsin - WIWest Virginia - WVWyoming - WYArmed Forces Americas - AAArmed Forces Europe - AEArmed Forces Pacific - APAmerican Samoa - ASGuam - GUNorthern Mariana Islands - MPPuerto Rico - PRU.S. Outlying Islands - UMU.S. Virgin Islands - VI "Use space or down arrow key to open the combobox."None Choose the correct State or Region unless you need to keep the current value. Add N/A if you do not have a state or region State ISO Code Address Name *Street Address Street Address 2 Street Address 3 Street Address 4 *City *Postal Code Location Code CUSTOMER SUPPORT CONTACT INFORMATION *Is your organization US-based? Yes No Tax Classification FEDERAL TAX FORM Type W8 W9 Attachments Add * File Browse Processing dropped files... Add International Tax Classification Active NFFE Passive NFFE (including trusts) Exempt beneficial owner Deemed compliant FFI Canadian Financial Institution Other Partner Jurisdiction Financial Institution Participating Foreign Financial Institution Non Participating Financial Institution Specified U.S. Person Not a Specified U.S. Person International Tax Form?supplier_view_key=f875906f2c6817f1eddb767302f647081238c9a0 (Change , Clear ) TAX REGISTRATIONS Use this section to add all your applicable tax registrations. Add Tax Registration -------------------------------------------------------------------------------- PAYMENT INFORMATION Coupa Pay requires Two Factor Authentication Setup on a mobile device using either an authenticator application (i.e., Google Authenticator) or SMS Text Messaging. Create a Remit To Address with your Banking Details. REMIT-TO ADDRESSES Add one or more Remit-To Addresses by either filling out a new Compliant Invoicing Form or choosing an Existing Remit-To Address. Add Remit-To Supporting Documentation?supplier_view_key=c22c4d157cc9831dbc69cb8aecbefaa600c047bb (Change , Clear ) Please attach a copy of a voided check or bank details on company letterhead. -------------------------------------------------------------------------------- Submit Decline Business Spend Management • English (United States) * Deutsch * English * Nederlands * Tiếng Việt * Türkçe * dansk * español * français * italiano * magyar * norsk * polski * português * română * suomi * svenska * čeština * Ελληνικά * русский * العربية * ไทย * 中文 * 日本語 * 한국어 Language and Region Settings