Vendor Registration Application

What type of Application is this?

New Application Revised Vendor Record

Are you a Virginia based firm?

Yes No

Identification

EIN

SSN

VA Department of Revenue ID

Business Designation

Select the Business Designation that applies to your Company

Corporation, Professional Corporation or Professional Association Sole Proprietorship or Self Employed Partnership, Joint Venture, Estate or Trust Other

Other - Please Describe

Business Classification

Business Classification

MBE Certification

Non-MBE Certification

Non-Minority

African American

Small Business - State

Small Business - Federal

Asian / Hawaiian

Large Business

Native American

American Woman

Solicitations

Check the type(s) of solicitations you wish to receive (check as many as apply).

Invitation to Bid

Request for Proposals

Contracting Categories

Please list all commodities and/or services categories that you wish to receive bid opportunities.

Commodities

Service Categories

Primary Type of Business

Signature

Full Name

Title

Date

Wilson, NC

Vendor Registration Application

Identification

Company Information

Mailing Address

Sales Contact

Business Designation

Business Classification

Solicitations

Contracting Categories

Please list all commodities and/or services categories that you wish to receive bid opportunities.

Signature

Wilson, NC

Vendor Registration Application

Identification

Company Information

Mailing Address

Sales Contact

Business Designation

Business Classification

Solicitations

Contracting Categories

Please list all commodities and/or services categories that you wish to receive bid opportunities.

Signature

Map Spreadsheet Columns to Import