USI » Business Office » Procurement » Vendor Application Form

*Company Name:
*Minority Vendor Status:
*Certified? If so, how?		If not minority vendor, enter N.A.
		Please mail minority certification form.

*Federal Tax I.D.:		All new vendors MUST provide a completed W-9 prior to being accepted as a vendor.
*Business type:

Address:
*Street Address:
Post Office Box:
*City:
*State:
*Zip:
Country:

Contact Information:
*Contact Name:
Title:
*Voice Number:
Fax Number:
Email Address:
Web URL:
*		Manufacturer-Manufacturer's Representative
		Distributor-Wholesaler
		Retailer
		Contractor
		Service Provider
		Other

Please list major products and lines or services for which your company would like consideration for future bid requests or quotes:

Please list electronic commerce capabilities i.e. EDI (Electronic Data Interchange), web based ordering system, CD ROM, etc.:

*Please provide names and phone numbers for at least 3 references of businesses similar to ours with whom you have recently done business:

*Required fields

Due to the overwhelming number of companies registering for USI�s bidder�s list, we cannot automatically send request for proposal packages. All items requiring a request for proposal package are listed on the website. Please monitor our site and call 812 464-1848 to order a specific request for proposal package.

Please click "send form" to forward your information. Contact Becky (812 464-1848) to request a specific bid package.

Procurement questions or comments

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