VENDOR APPLICATION FORM
Initial Application     Revision  
Company Name:*

* Required Field

Type of Business:

Corporation Partnership Sole Proprietor

Manufacturer Wholesaler Retailer
Distributor Service Construction Contractor
Year Founded:

Address to mail purchase order and bids:*

Accounts  Receivable Address:

Contact Person for Pricing and Bids:

Contact Person for Customer Service:

Email Address:*

Telephone No.:

Telephone No.:* Fax:

Fax:

Internet Web Site:

HTTP//WWW.

Is business at least 51% Minority Owned? If yes, check all that apply:

Yes

No

Black    

Native American 

Hispanic Asian Indian 
Female Other

 

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