New Suppliers Application – Resale/Retail/COGS Business Contact InformationCompany's Legal Name(Required)Other Business Name(s)/DBAsPhone(Required)Website Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Mailing Address is Same as Billing Address(Required) Yes No Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Ordering Contact Name(Required) First Last Ordering Contact Email(Required) Ordering Contact Phone NumberBilling Contact Name First Last Billing Contact Email Billing Contact Phone NumberProduct InformationAre you a seafood vendor?(Required) Yes No Seafood Vendor & Product InformationProduct Name(s)(Required)Species (common & scientific)(Required)Traceability & OriginCountry of Origin(Required)Harvest or farm location (region/watershed/name of fishery)(Required)Is full traceability available?(Required) Yes No Can you provide documentation tracing products from source to delivery?(Required) Yes No Lot/batch tracking system description(Required)Harvesting / Farming DetailsIs the product:(Required) Wild-caught Farmed Catch method (wild):(Required) Handline / hook & line Trap / pot Trawls Seine Other (please specify) Specify Other:Catch method (farmed):(Required) Open net pen Cage/Net Pen Land-based / recirculating Pond Bottom Culture Other (please specify) Specify Other:Feed used (for farmed seafood):(Required)Antibiotic or chemical use :(Required)Sustainability & Seafood Watch® Compliance Are you a Seafood Watch Partner?(Required) Yes No What is the Seafood Watch® rating for this product?(Required) Green (Best Choice) Yellow (Good Alternative) Red (Avoid) → auto disqualifier Not rated If rated, please provide link to documentation confirming rating or upload documentation belowFileAccepted file types: pdf, jpg, Max. file size: 50 MB. PDF and JPG file formats acceptedThird-Party CertificationsDoes your product have any of the following certifications? (select all that apply)(Required) BAP (Best Aquaculture Practices) ASC (Aquaculture Stewardship Council) MSC (Marine Stewardship Council) None Upload current certification documents Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 50 MB, Max. files: 6. Social ResponsibilityDo you have a documented labor policy?(Required) Yes No Check each to verify that your supply chain is free from:(Required) Forced labor Human trafficking Worker exploitation Are your operations audited for labor practices?(Required) Yes No By whom?(Required)Supplier PracticesDo you prioritize sourcing regions with strong environmental regulations?(Required) Yes No Have you ever been flagged for sustainability or compliance violations?(Required) Yes No Please explain your sustainability or compliance violations:(Required)Operational & ComplianceDo you update product sustainability ratings as they change?(Required) Yes No Are you willing to participate in annual supplier reviews/audits?(Required) Yes No Your Product InformationGeneral Description of Products Offered(Required)(You can also attach a detailed list, including product ingredients.)Certifications HeldCertifications USDA Organic Certified Naturally Grown American Grass-fed (AGA) Animal Welfare Approved Alcoholic Beverage License Cold Storage License Good Agricultural Practices Approved Market Milk Permit Certifications Meat Processing License Feed-yard Registration License (USDA) Poultry Plant License (USDA) Processed Food Registration (CA DPH) Winery Permit (ABC) Basic Winery Permit Other (Enter Below) Certification #sOther InformationAre your products labeled in accordance with State and Federal regulations? View Regulations Here.Are your products labeled in accordance with State and Federal regulations?(Required) Yes No Do you have liability insurance coverage?(Required) Yes No What BriarPatch location you are applying for placement in?(Required) Grass Valley Auburn What is your regular delivery schedule?(Required)What are your ordering deadlines?(Required)Describe any shipping or freight charges, including terms for reducing or waiving(Required)Are you an ECRS Gateway Supplier?(Required) Yes Not currently, but I am interested in becoming an ECRS gateway supplier. No Are you interested in enabling electronic purchase orders & invoicing? Yes No Are you willing to receive payment via ACH?(Required) Yes No What is your invoicing process?(Required)(If not via Gateway. Check all that apply.) Email Hard copy on delivery Other Email File Type(s) CSV Excel PDF TXT Hard copy type Printed Hand-written Please describe.What is your ordering process?(Required)(If not via Gateway. Check all that apply.) App Web Portal Email Fax Phone Other Please describe:Do you publish regular price list updates?(Required) Yes No Select frequency Daily Weekly Monthly Quarterly Annually Format CSV Excel PDF TXT Printed hard copy Are you offering an initial order discount or other promo?(Required)Please describe.Diversity, Equity, and InclusionBriarPatch is dedicated to building a more diverse, equitable, and inclusive group of product offerings in our stores. Feel free to tell us if your company is: Asian-owned Black-owned Co-op-owned Disabled-owned Diverse-owned Hispanic or Latin American-owned Indian-owned Indigenous/Native American owned LGBTQIA+ – owned Veteran-owned Woman-owned We love to share vendor stories with your permission. Would you like BriarPatch to promote your business as DEI-owned? Yes No Anything else you’d like to let us know?Required DocumentsWe require a current insurance certificate with at least $1,000,000 in general liability coverage naming BriarPatch Cooperative of Nevada County, Inc. as additional insured. Download a blank W-9 form here. COI must be named as follows: BriarPatch Cooperative of Nevada County, Inc. 290 Sierra College Dr. Grass Valley, CA 95945 Completed W-9 form.(Required)Max. file size: 50 MB. Certificate of Insurance(Required)Max. file size: 50 MB. Other DocumentsMax. file size: 50 MB. Untitled First Choice Second Choice Third Choice Δ