ITB No. 17-425-001-F Office Furniture and Files Section 7.2 Authorized Servicing Dealer & Manufacturer's Representatives Form Servicing Dealer Information DEALER NAME: [Enter Dealer's Name] DEALER FEID NO.: [Enter Dealer's Federal Employer Identification Number] MFMP / SPURS [Enter Dealer's MFMP / SPURS Vendor Number, if Known] VENDOR NO.: STREET ADDRESS: [Enter Dealer's Street Address] CITY, STATE and [Enter Dealer's City, State and ZIP] ZIP: INTERNET [Enter Dealer's Internet Address] ADDRESS: TELEPHONE NO.: [Enter Dealer's Main Telephone Number] TOLL-FREE NO.: [Enter Dealer's Main Toll-Free Telephone Number, if Available] FAX NO.: [Enter Dealer's Main Fax Number] Manufacturer Representation MANUFACTURER'S REPRESENTATIVE [Enter Manufacturer's Representative Name] NAME: TITLE: [Enter Manufacturer's Representative Title] STREET ADDRESS: [Enter Manufacturer's Representative Street Address] CITY, STATE and [Enter Manufacturer's Representative City, State and ZIP] ZIP: E-MAIL ADDRESS: [Enter Manufacturer's Representative E-Mail Address] TELEPHONE NO.: [Enter Manufacturer's Representative Telephone Number] TOLL-FREE NO.: [Enter Manufacturer's Representative Toll-Free Telephone Number, if Available] CELL PHONE NO.: [Enter Manufacturer's Representative Cell Phone Number (Optional)] FAX NO.: [Enter Manufacturer's Representative Fax Number] GORAPHIC AREA [Enter Manufacturer's Representative Geographic Area of Territory] OF TERRITORY: NOTES: Note: Please make sure the Ordering Instructions information provided above matches the MyFloridaMarketPlace ("MFMP") Vendor Registration account information (http://vendor.myfloridamarketplace.com/). PLEASE DUPLICATE THIS FORM ON ADDITIONAL TABS AS NEEDED
ITB No. 17-425-001-F Office Furniture and Files Section 7.2 Authorized Servicing Dealer & Manufacturer's Representatives Form Servicing Dealer Information DEALER NAME: [Enter Dealer's Name] DEALER FEID NO.: [Enter Dealer's Federal Employer Identification Number] MFMP / SPURS VENDOR NO.: [Enter Dealer's MFMP / SPURS Vendor Number, if Known] STREET ADDRESS: [Enter Dealer's Street Address] CITY, STATE and ZIP: [Enter Dealer's City, State and ZIP] INTERNET ADDRESS: [Enter Dealer's Internet Address] TELEPHONE NO.: [Enter Dealer's Main Telephone Number] TOLL-FREE NO.: [Enter Dealer's Main Toll-Free Telephone Number, if Available] FAX NO.: [Enter Dealer's Main Fax Number] Manufacturer Representation MANUFACTURER'S REPRESENTATIVE NAME: [Enter Manufacturer's Representative Name] TITLE: [Enter Manufacturer's Representative Title] STREET ADDRESS: [Enter Manufacturer's Representative Street Address] CITY, STATE and ZIP: [Enter Manufacturer's Representative City, State and ZIP] E-MAIL ADDRESS: [Enter Manufacturer's Representative E-Mail Address] TELEPHONE NO.: [Enter Manufacturer's Representative Telephone Number] TOLL-FREE NO.: [Enter Manufacturer's Representative Toll-Free Telephone Number, if Available] CELL PHONE NO.: [Enter Manufacturer's Representative Cell Phone Number (Optional)] FAX NO.: [Enter Manufacturer's Representative Fax Number] GORAPHIC AREA OF TERRITORY: [Enter Manufacturer's Representative Geographic Area of Territory] NOTES: Note: Please make sure the Ordering Instructions information provided above matches the MyFloridaMarketPlace ("MFMP") Vendor Registration account information (http://vendor.myfloridamarketplace.com/). PLEASE DUPLICATE THIS FORM ON ADDITIONAL TABS AS NEEDED