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					                                   DELAWARE STATE UNIVERSITY
                                                  VENDOR/SUPPLIER PROFILE
                                                          PLEASE TYPE OR PRINT

COMPANY NAME ____________________________________________________________________________________________

Contact Name _________________________________________________Title __________________________________________

Address_____________________________________________________________________________________________________
               Street                                  City/State                                      Zip

Phone _______________________ Fax_____________________ Email______________________ Website___________________

REMIT PAYMENTS TO: (leave blank if same as above)

Address ____________________________________________________________________________________________________
               Street                           City/State                             Zip

Phone _______________________                                           Fax_______________________

Payment Terms_______________________________                           Credit Card Payments Accepted               Yes   No

OPERATING AS: (check the one that best applies)                 Corporation – incorporated under the laws of the state of _____

                        Partnership                 Sole Proprietor                      Non-Profit Organization

Federal Employee Identification Number (FEIN) or Social Security # _____________________________________________________

BUSINESS STATUS:

Years In Present Business ___________________ Number of Employees______________ Annual Sales_____________________

OWNERSHIP CLASSIFICATION: (Check all that apply – see attached definitions)

  African American             Hispanic          Asian-Indian            Asian Pacific              Native American       Woman Owned

              Small Business        Veteran-Owned Small Business        Service Disabled Veteran-Owned Small Business


KEY CONTACTS (Person(s) authorized to sign Bids, Offers and Contracts):
              Name                                                Title                                                  Phone




REFERENCES YOUR COMPANY DOES BUSINESS WITH:
              Company Name                                            Contact Person                                     Phone




AGENCIES YOUR COMPANY IS CERTIFIED WITH: (Complete this section if you are a MBE/WBE and attach certification.)
                                                                                                   Registration or            Date Issued
      Agency Name                             Address                        Phone                 Certification #




Submitted by: ________________________________________                                              Date: ____________________

Return completed form to: Office of Purchasing, 1200 N. DuPont Hwy., Dover, DE 19952 / Phone: 302-857-6270 Fax: 302-857-6278
                                          OWNERSHIP CLASSIFICATION DEFINITIONS

Minority & Women Business Enterprises (M/WBE)
                   A minority and/or women business enterprise is a business that is at least 51 percent owned,
                   controlled and actively managed by minority group members who are U.S. citizens or persons
                   lawfully admitted to the U.S. for permanent residence.

African American              A U.S. citizen having origins in any of the Black racial groups of Africa

Hispanic                      A U.S. citizen of true-born Hispanic heritage, from any of the Spanish-speaking areas of Latin
                              America or the following regions: Mexico, Central America, South America and the Caribbean
                              Basin only.

Asian-Indian                  A U.S. citizen whose origins are from India, Pakistan or Bangladesh

Asian-Pacific                 A U.S. citizen whose origins are from Japan, China, Indonesia, Malaysia, Taiwan, Korea,
                              Vietnam, Laos, Cambodia, the Philippines, Thailand, Samoa, Guam, the U.S. Trust Territories of
                              the Pacific or the Northern Marinas

Native American               A person who is an American Indian, Eskimo, Aleut or Native Hawaiian, and regarded as such by
                              the community of which the person claims to be a part. Native Americans must be documented
                              members of a North American tribe, band or otherwise organized group of native people who are
                              indigenous to the continental United States and proof can be provided through a Native American
                              Blood Degree Certificate (i.e., tribal registry letter, tribal roll register number).

*Small Business               The SBA defines a small business as “one that is independently owned and operated and which is
                              not dominant in its field of operation” The law also states that in determining what constitutes a
                              small business, the definition will vary from industry to industry to reflect industry differences
                              accurately. SBA's Small Business Size Regulations implement the Small Business Act's mandate
                              to SBA. SBA has also established a table of size standards, matched to North American Industry
                              Classification System (NAICS) industries.

**Veteran Owned Small Business
                   A small business that: (i) is at least 51% unconditionally owned by one or more veterans (as
                   defined at 38 U.S.C. 101(2); or in the case of any publicly owned business, at least 51% of the
                   stock of which is unconditionally owned by one or more veterans; and (ii) whose management
                   and daily business operations are controlled by one or more veterans.

**Service Disabled Veteran Owned Small Business
                      A small business that: (i) is at least 51% unconditionally owned by one or more veterans (as
                      defined at 38 U.S.C. 101(2), with a disability that is service connected, as defined in 38 U.S.C.
                      101(16); or in the case of any publicly owned business, at least 51% of the stock of which is
                      unconditionally owned by one or more service-disabled veterans; and (ii) whose management and
                      daily business operations are controlled by one or more service-disabled veterans or, in the case
                      of a veteran with permanent and severe disability, the spouse or permanent caregiver of such
                      veteran.




Source: National Minority Supplier Development Council, Inc. (www.nmsdcus.org)
*Source: Small Business Administration (www.sba.gov)
**Source: Pentagon Renovation Program (www.export.gov/iraq/pdf/sb_criteria.pdf)

				
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