Vendor Application Form

Vendor Application Form

Submitted with Form W-9
Note:  Payment Terms Net 30 (payment will be made 30 days after invoice date)

Please enter the information below, then select the "Print this Form" button below to return a page which is your Vendor Application form. Print the form, sign it, and fax it to Procurement at (508) 457-2192.

Business Mailing Address

- - - -

Invoice Remittance Address

- - - -

Tax and Withholding Information (please select one)

Corporation Partnership
Medical Corporation Non-Resident
Sole Proprietorship/Independent Contractor Government Entity
Tax Exempt Organization under IRS (501) Rules 1099

Business Type Classification (please check all that apply)

American Indian Owned Veteran Owned Business
HUB Zone Firm* Service Disabled Veteran Owned
Small Business Disabled
Large Business (500+) Nonprofit Organization
Disadvantaged Business Sheltered
Woman Owned Business Foreign Supplier
Limited Liability Company Historically Black College/University
* Hub Zone and Small Disadvantaged Business must provide a copy of their certificate with this form. 
FAR Clause 52.219-1(d) (2) Under 15 U.S.C 645(d), any person who misrepresents a firm’s status as a small, HUBZone small, small disadvantaged, or women-owned small business concern in order to obtain a contract to be awarded under the preference programs established pursuant to section 8(a), 8(d), 9 or 15 of the Small Business Act or any other provision of Federal law that specifically references sections 8(d) for a definition of program eligibility, shall: (i) Be punished by imposition of fine, imprisonment or both; (ii) Be subject to administrative remedies, including suspension and debarment and (iii) Be ineligible for participation in programs conducted under the authority of the Act.

Purchasing Key (please select one)

Maintenance Distributors
Office Supplies/Furniture Transportation Services
Building Trades/Contractors Computer Supplies
Manufacturers Marine/Rigging Shop Supplies
Electronics Services


Last updated: September 28, 2017