| FEDERAL ID # | |
| SS # | |
| VENDOR # | |
| VENDOR NAME | |
| DATE | |
| DOING BUSINESS AS | |
| INCORPORATED? | |
| | PURCHASE ORDER ADDRESS |
| NAME | |
| STREET | |
| P.O. BOX | |
| CITY | |
| STATE | |
| ZIP | |
| FEDERAL ID # | |
| SS # | |
| | REMITTANCE ADDRESS |
| NAME | |
| STREET | |
| P.O. BOX | |
| CITY | |
| STATE | |
| ZIP | |
| | QUOTATION ADDRESS |
| NAME | |
| STREET | |
| P.O. BOX | |
| CITY | |
| STATE | |
| ZIP | |
| | |
| COUNTY | |
| E-MAIL |
ex: john@mycompany.com |
| CONTACT PERSON | |
| CONTRACTOR'S LICENSE NO. (IF APPLICABLE) | |
| PHONE | |
| FAX | |
| YEARS ESTABLISHED | |
| TERMS OF PAYMENT | |
| PAYMENT DISCOUNT AVAILABLE | |
| IF YES, EXPLAIN | |
| THIS FIRM CERTIFIES THAT IT IS A (IF APPLICABLE) | |
| | CONTACTS |
| MANAGER | |
| PHONE | |
| FAX | |
| SALES REPRESENTATIVE | |
| PHONE | |
| FAX | |
| INSIDE SALES REPRESENTATIVE | |
| PHONE | |
| FAX | |
| ACCOUNTS RECEIVABLE CONTACT | |
| PHONE | |
| FAX | |
| | PRODUCT(S) AND/OR SERVICE(S) |
| TYPE |
Please list the type of product(s) and/or service(s) that your company can provide |
| NAME | |
| TITLE | |
| DATE | |
| | |