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You are here: Home Controller's Office Acct Operations Forms Instructions for Vendor Survey

Instructions for Vendor Survey

by Fehler,Lori T. last modified Jun 10, 2013 10:01 AM

Section 1

Vendor Name – Formal name as filed with the Internal Revenue Service

Website Address – URL for your business (if applicable)

Remit Address, City, State, Zip – List all addresses to which payments could be remitted

Accounting Contact & Title, Phone Number, E-mail – Person responsible for your accounts receivable

Order Address, City, State, Zip – List address to which you would like PO’s sent

Sales Contact & Title, Phone Number, E-mail – Person responsible for all purchase orders placed

Section 2

PO Dispatch Method – Please specify one (1) method that the University will transmit PO’s to your company: e-mail or mail

Section 3

ACH Payments -  May the University send electronic payments directly to your bank account? How would you like to receive the remittance information? E-mail or CCD (the invoice information is transmitted directly to the bank along with the payment)?

Electronic Invoicing – Is your company capable of transmitting electronic invoices to the University?  This can either be via cXML (an electronic data interchange format) or via the University’s web-based vendor self-service portal in PeopleSoft.  This does not include e-mailed invoices.  For cXML invoicing, please provide contact information for your IT technical person.

Section 4

Type of Product or Service – Please be specific.

DUNS Number – Please provide your DUNS number.

NAICS Code – The NAICS codes are organized by Industry Group.  For example, if you are a computer manufacturer selling computer equipment to the University, the appropriate NAICS code is 3571 – Electronic Computers.  If you are an establishment primarily engaged in the retail sale of computers, then the appropriate NAICS code is 5734 – Computer and Computer Software Stores.  Complete list of NAICS codes and their descriptions .

Minority-Owned Business – Are you a minority-owned business?  Information on the Minority Business Development Agency .
Additional general information about these classifications and information about the certification process.   Note: UofL is not recommending or endorsing MWBE but is including this link to assist you in understanding the various small business classifications.

Woman-Owned Business – Are you a woman-owned business?   Information on the SBA's role in determining small disadvantaged business status .
Additional general information about these classifications and information about the certification process.   Note: UofL is not recommending or endorsing MWBE but is including this link to assist you in understanding the various small business classifications.

Small/Disadvantaged Business – To determine if you are a small/disadvantaged business, use the Small Business Administration (SBA) website  and select all applicable classifications provided under section 4. of the U of L Vendor Survey Form.  The websites listed on the form provide a description of these classifications.

Section 5

Validly organized with authority to do business in KY – Dependent upon your particular business, the Commonwealth of Kentucky has different requirements to do business in the state.  For example, if you are an out of state entity without offices, personnel or manufacturing facilities in the state, have you registered with the Secretary of State?  Another example would be that certain businesses are required to have specific licenses in order to provide services in the state.  By answering yes, you are indicating that you are properly organized (e.g. LLC, S-Corp, partnership, sole-proprietorship), that you have any required licenses, and that you are otherwise qualified to do business in the state. 

Excluded, debarred or otherwise ineligible to participate – Federal and state governments maintain multiple lists of individuals or entities that have been excluded, disbarred, suspended, or otherwise deemed ineligible from participation in and/or receiving funds from government-funded programs.  One such list maintained by the Federal government is the DHHS OIG LEIE .  If you have been excluded, disbarred, suspended, or otherwise deemed ineligible, please provide an explanation in the space provided on the form so that your eligibility to provide goods or services to the University can be assessed.

Principals or their family members employed by the University of Louisville or any of its affiliates -  The following is a list of University of Louisville affiliates:

  • University of Louisville Research Foundation, Inc.
  • University of Louisville Athletic Association
  • University of Louisville Medical School Fund, Inc.
  • University of Louisville Foundation, Inc. and Affiliates
  • ULH, Inc.
  • University of Louisville and Jewish Hospital Cardiovascular Innovation Institute, Inc.
  • OMHS/UofL Cancer Research Center, Inc.


Section 6

Please certify the accuracy of the information provided in the survey, and sign & date the form.

Please return the survey, along with a W-9 form to the University department that requested the forms.

Last update: September 2009

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