Supplier Profile

The following information is required to add or update vendor records in supplier database. Incomplete or inaccurate information may delay processing of purchase orders and/or payments. Please note the areas with arrows are collapsed to make viewing easier. If you wish to expand the area, please click on the section name or arrow to expand.

Parent Company:

Parent Company (If Applicable)

Company's Legal Name:

Tax ID Number:

DUNS Number:

Company General Information - Name:

Title:

Phone:

Fax:

Email:

Address 1:

Address 2:

City:

State:

Zip Code:

County:

Internet Website (URL):

Locations:

How many locations do you have?

Location Sites:

Where are they located?

Remittance Information - Payable Contact - Name:

Title:

Phone:

Fax:

Email:

Address 1:

Address 2:

City:

State:

Zip Code:

County:

Business Information - Size Codes:

*SMALL BUSINESS SIZE CRITERIA AS SET FORTH IN 13 CFR PART 121 IS AVAILABLE ON THE SMALL BUSINESS ADMINISTRATION’S (SBA) WEBSITE AT WWW.SBA.GOV/SIZE

Business Type:

Small Business Concerns:

**SBA CERTIFICATION IS REQUIRED FOR FIRMS CLAIMING EITHER 8(A) OR HUBZONE STATUS (WWW.SBA.GOV)

Note: the small business size standard is 500 employees.:

Certifications:

State/Local WBE/MBE/DBE Certifications (Enter all certifications, certifying agencies and expiration dates)

Primary NAICS Code:

This would represent the industry that comprises the majority of the firm's sales and receipts.

Additional Codes:

Maximum 4.

Retailer or Wholeseller:

Yes

Type of Business:

Commodity Codes:

Please list all of the commodity codes (max 5)

Service Codes:

Please list all of the service codes (max 5)

IRS Form W-9:

Annual Representations and Certifications:

Current Catalog and Pricing:

Health and Safety Performance Survey:

Required for all vendors providing field services

Product and Service Information:

Relationships

Supplier Profile