Vendor Application Form

APPLICATION IS:



ADDRESS INFORMATION:
REMITTANCE ADDRESS (if different from above):
VENDOR CLASSIFICATION:
MINORITY BUSINESS CLASSIFICATIONS:
MINORITY BUSINESS ENTERPRISE (MBE) - A small business that is certified as being at least fifty-one percent (51%) controlled by one or more ethnic minority persons of either gender. (An ethnic minority person shall be described as African-American, Hispanic Americans, Native Americans, or Asian & Pacific Islander Americans).
WOMEN BUSINESS ENTERPRISE (WBE) - A small business that is certified as being at least fifty-one percent (51%) controlled by one or more women.
HANDICAPPED BUSINESS ENTERPRISE (HBE) - A small business that is certified as being at least fifty-one percent (51%) controlled by one or more handicapped persons of either gender.
PLEASE CHECK ALL THAT APPLY: