FULL LEGAL NAME (PRINT) FEDERAL TAXPAYER DELIVERY DATE NUMBER (ID#) (Company name as it appears with your Federal Taxpayer Number) BUSINESS NAME/DBA NAME/TA NAME FEDERAL TAXPAYER NUMBER (If different than the Full Legal Name) (If different than ID# BILLING NAME FEDERAL TAXPAYER NUMBER (Company name as it appears on your invoice) (If different than ID# above) PURCHASE ORDER ADDRESS PAYMENT ADDRESS CONTACT NAME/TITLE (PRINT) SIGNATURE (IN INK) DATE E-MAIL ADDRESS TELEPHONE NUMBER TOLL FREE TELEPHONE FAX NUMBER NUMBER *BUSINESS LARGE SMALL CLASSIFICATION *Business Classification definitions can be viewed at *Is your Classification certified by the Virginia Department of Small If yes, provide Certification Number: Business and Supplier Diversity (SBSD)? Yes No *For assistance with certification questions, please visit: Is any member of the firm an employee of the Commonwealth of Virginia who has a personal interest in this contract pursuant to the Code of Virginia? YES____________ NO_____________ SIGNATURE _____________________________________ Date: _______________________ THIS IS NOT AN Revised 7/01/2017 I. PURPOSE: The intent and purpose of this Invitation For Sealed Bid is to establish a term contract with one or more qualified sources that can provide PT Gear for Virginia Polytechnic Institute and State University (Virginia Tech), an agency of the Commonwealth of Virginia. II. BACKGROUND:
FULL LEGAL NAME (PRINT) (Company name as it appears with your Federal Taxpayer Number) FEDERAL TAXPAYER NUMBER (ID#) DELIVERY DATE BUSINESS NAME/DBA NAME/TA NAME (If different than the Full Legal Name) FEDERAL TAXPAYER NUMBER (If different than ID# BILLING NAME (Company name as it appears on your invoice) FEDERAL TAXPAYER NUMBER (If different than ID# above) PURCHASE ORDER ADDRESS PAYMENT ADDRESS CONTACT NAME/TITLE (PRINT) SIGNATURE (IN INK) DATE E-MAIL ADDRESS TELEPHONE NUMBER TOLL FREE TELEPHONE NUMBER FAX NUMBER *BUSINESS CLASSIFICATION LARGE SMALL *Business Classification definitions can be viewed at *Is your Classification certified by the Virginia Department of Small Business and Supplier Diversity (SBSD)? Yes No If yes, provide Certification Number: *For assistance with certification questions, please visit: Is any member of the firm an employee of the Commonwealth of Virginia who has a personal interest in this contract pursuant to the Code of Virginia? YES____________ NO_____________ SIGNATURE _____________________________________ Date: _______________________ THIS IS NOT AN Revised 7/01/2017 I. PURPOSE: The intent and purpose of this Invitation For Sealed Bid is to establish a term contract with one or more qualified sources that can provide PT Gear for Virginia Polytechnic Institute and State University (Virginia Tech), an agency of the Commonwealth of Virginia. II. BACKGROUND: