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Vendor Application Form
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  Vendor Application Form (.xls)
Application Type
New Change Add/Delete
Federal I.D. # or Social Security #
Prinicipal Business Name Year Business Established
Prinicipal Business Address
City  
 
State  
 
Zip Code  
 
Country  
 
Mailing Address ( if different than Principal Business Address)
City  
 
State  
 
Zip Code  
 
Country  
 
Gross Annual Sales Email
Type of Organization
Proprietorship
Partnership
Non-Profit Organization
Corporation, Incorporated Under the Laws of the State of
Names of Officers, Members or Owners of Concern, partnership, Joint Venture, Etc.
President Vice President
Secretary Treasurer
Owners or Partners (Those persons or concerns having a financial interest of five percent(5%) or greater)
Black Female Hispanic Other
% of Ownership
% of Ownership
% of Ownership
% of Ownership
Is this business a public traded corporation? Yes No  
Primary Contact Person (Bids/Quotes/Orders)
Name Official Capacity
Phone No. Fax No.
Persons Authorized to sign Bids/Proposals/Contracts/Agreements
Name Official Capacity
Name Official Capacity
Name Official Capacity
Primary Type of Business (Please check one only!)
Funeral Home Cemetery Other
Checklist of Documents to be submitted with application
Yes No Terms & Conditions
Yes No Non Disclosure Agreement
Yes No Distributor Agreement
   
         
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