Vendor Registration Form Purchasing Dept. 999 Avenue H, Northeast Winter Haven, FL 33881-4299 www.polk.edu/purchasing a. Corporate Name: b. Issue Checks to: (pay to the order of) 1. Company Name Invoices must be submitted using the name in 1b Street / P.O. Box County 2. Mailing Address Purchase Orders will be City State Zip + 4 sent to this address 3. Contact Person Contact Person Contact for quotes, etc. Telephone # Fax Toll Free Cell Phone 4. Contact Information Internet & Telephone EMail Address Website Home Page Street Address 5. Payment Address to send payments City State Zip + 4 see section 1b above 6. Corporate Headquarters Street / P.O. Box If different from above City State Zip + 4 address, see section 1a above Federal Employer Identification Number Social Security Number 7. IRS required information: Only one is required The purpose of collecting the FEIN/SSN is to comply with IRS regulations to file 1099 forms. 8. Type of Business: Corporation Sole Proprietor Partnership Is your company is certified by the of Florida’s 9. M/WBE Status: Yes No Office of Supplier Diversity as a Minority/Woman Owned Business? Goods/services sold: 10. To be included in our database for Invitations to Bid (ITB), list below the appropriate 5-digit Commodity Code Numbers for the ITBs you are interested in. A and passwords to www.nigp.com are “hotlink” 11. Commodities: available at our website at: www.polk.edu/businessandcommunity/purchasing/Pages/VendorRegistration.aspx Commodity Please attach brochures & catalogs which may assist in our assessment of your capabilities, and knowledge of your products or services.
Vendor Registration Form Purchasing Dept. 999 Avenue H, Northeast Winter Haven, FL 33881-4299 www.polk.edu/purchasing 1. Company Name Invoices must be submitted using the name in 1b a. Corporate Name: b. Issue Checks to: (pay to the order of) 2. Mailing Address Purchase Orders will be sent to this address Street / P.O. Box County City State Zip + 4 3. Contact Person Contact for quotes, etc. Contact Person 4. Contact Information Internet & Telephone Telephone # Fax Toll Free Cell Phone EMail Address Website Home Page 5. Payment Address to send payments see section 1b above Street Address City State Zip + 4 6. Corporate Headquarters If different from above Street / P.O. Box address, see section 1a above City State Zip + 4 7. IRS required information: Only one is required Federal Employer Identification Number Social Security Number The purpose of collecting the FEIN/SSN is to comply with IRS regulations to file 1099 forms. 8. Type of Business: Corporation Sole Proprietor Partnership 9. M/WBE Status: Is your company is certified by the of Florida’s Office of Supplier Diversity as a Minority/Woman Owned Business? Yes No 10. Goods/services sold: 11. Commodities: To be included in our database for Invitations to Bid (ITB), list below the appropriate 5-digit Commodity Code Numbers for the ITBs you are interested in. A “hotlink” and passwords to www.nigp.com are available at our website at: www.polk.edu/businessandcommunity/purchasing/Pages/VendorRegistration.aspx Commodity Please attach brochures & catalogs which may assist in our assessment of your capabilities, and knowledge of your products or services.
Vendor-Registration-Form.docx