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Purchasing Division - Vendor Application

PURCHASING DIVISION
9551 West Sample Road
CORAL SPRINGS, FL 33065
954-344-1100

VENDOR APPLICATION

Application Instructions

1. Name of Business (if individual, enter last name first).

2. Street or P.O. Box address to which bid requests are to be mailed.

3. City

State

ZIP

-

4. Contact to whom bid requests are to be mailed. Enter none if no one person should be named.

5a. Telephone Number
(include area code)

5b. Toll Free Number
(if available)

5b. FAX
(if available)

5c. E-mail
(if available)


6a. Federal Employer's ID Number

or

6b. Social Security Number, if individual

7. Select the actual class-items from the 3 digit Commodity Class Codes. Print the appropriate sheets and attach them to this application.

8. Address of main business office if different from #2 or #3.

9. If incorporated, in which state and date .

10. Location of principal factory or warehouse.

11. If you currently hold any Florida State contracts, list contract numbers and expiration dates.

12. Principal line of business.

13. How long in present business.

14. Bidder's comments:

15. The undersigned hereby certifies that the above and foregoing information is a full, true, and correct statement of the facts. It is understood that failure to bid or return the proper no bid form on three (3) consecutive bid invitations for any given Commodity Class could result in removal from the Bidder's mailing list for that Class.

____________________________
Authorized Signature
Check this application to ensure that a correct response has been made to each question. Any omissions will result in follow-up inquiry and will delay your entry onto our Bidder's lists.

Typed Name

Title

Date

(After you print the form, be sure to sign your name above Authorized Signature.)