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Vendor Information

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					                              ∰ Vendor Information
The following information is required to enter a vendor in the 3PSC Accounting System.

Vendor Identification
Company Name
Company Contact Name
Company Address (for Purchase Orders)
Phone
FAX
Alternate Contact
Alternate Phone
Email address
Email address (for Cc)
Payment Checks to be made out to:
Vendor Account No. Assigned to 3PSC
Company Tax ID


Vendor Business Category (Select ONE Category)
                                                                                      Check One Box
                                                                                          Below
10a. Small Business (SB)
10b. Large Business (LB)
11. Small Disadvantaged Business (SDB)
12. Women-Owned Small Business (WOSB)
13. Historically Black Colleges, Universities (HBCU), or Minority Institutions (MI)
14. HUBZONE Small Business (HUBZONE SB)
15. Veteran-Owned Small Business (VOSB)
16. Service-Disabled Veteran-Owned Small Business
17. Alaska Native Corporations (ANCs) And Indian Tribes That Have Not Been
Certified By The SBA As SDBs (SDBs certify under 11 above)
18. Alaska Native Corporations (ANCs) And Indian Tribes That Are Not Small
Businesses

Vendor Business Areas
Business Area (NAICS Codes May be used and are required for any area in which the     Small Business
Vendor is certifying above as a Small Business). Rows may be added to this table as    Certification
required.                                                                             Above Applies
                                                                                         Yes/No
Person Completing Form
Name of Person Completing Form
Date of Completion



Please email the completed form to: WS-Vendor@3psc.com

				
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posted:8/7/2011
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