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 New Vendor Application Form

 

Purchasing Home Page

 

 
Revised:  May 09, 2008
Federal ID or SSN *
Company Name *
Applicant Name *

Title
Street Address *
Mailing Address *
City *
State *

Zip

 *
Phone *

Fax
Email

Enter Payment Address if different from the address above.
Payment Mailing Address
Payment City
Payment State

Payment Zip
Organization Type Individual Partnership Non-Profit
Corporation, Incorporated in what State? Other:
Years in business
Type of Business Manufacturer Factory Representative
Wholesale Dealer
Retail Dealer Other:
A Small Business employs less than 50, realizes a gross annual income of less than $2 million, and is independently owned and operated (not a subsidiary of another firm).  A Minority Business is any firm in which minority persons collectively own and share in earnings of 51 percent (51%) or more of the firm.  Minority means Black, Hispanic, Asian, Pacific Islander, American Indian, Alaskan Native, and Women, regardless of race or ethnicity.
Vendor Type Small Minority Sheltered Workshops Construction Unlimited Limited Contractor
Other:
Minority Status Black Hispanic Asian Pacific Islander American Indian Alaskan Native Female
Commodity Class
Code(s)

Click here for Commodity Class Codes Listing.

* Required fields.