Vendor Qualification Form

General Company Information

Company Name

Mailing Address

City

State

ZIP

Business Type

If Other, Please Specify

Phone

Fax

Website

Part of a Union?

If yes, which one?

Type(s) of Classification: include ALL that apply (MBE, WBE, VBE, etc.)

Please refer to http://www.sba.gov for definitions of Small, Socially and Economically Disadvantaged Businesses.

What Year Established

Number of Years in Operation Under Current Name

Any Former Names Business Operated Under

Is the business a subsidiary or division of another company?

If so, name of subsidiary or division

Date of Incorporation (if applicable)

State of Incorporation

Name of CEO

Names of Vice Presidents, Secretary, Treasurer

Date of Partnership (if applicable)

Type of Partnership (if applicable)

Provide categories of product and or services.

Has your organization had any judgments, claims, or arbitration suits filed against it or its officers within the last 5 years?

If yes, add explanation

Provide references that you currently do business with along with contact names and phone numbers.

Annual Sales Volume for the Last Three Years