Vendor Application Form

Please enter the information below, then select the "Printable 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.

Vendor Information
Vendor Name:		TIN/SSN:
Address:
City:
State:		Zip Code:
Phone:	- -	Fax:	- -
Contact:		Email:
Invoice Remittance Address
Address:
City:
State:		Zip Code:
Phone:	- -	Fax:	- -
Contact:		Email:

Tax and Withholding Information (please check all that apply)
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
* 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. **Hub Zone and Small Disadvantaged Business must provide a copy of their certificate with this form.
Purchasing Key (please check all that apply)
Maintenance	Distibutors
Office Supplies/Furniture	Transportation Services
Building trades/Contractors	Computer Supplies
Manufacturers	Marine/Rigging Shop Supplies
Electronics	Services
Other

Vendor's signature: ______________________________________ Date: _____/_____/_____

MS#1 • Woods Hole, MA 02543 • 508.289.2371 • Fax 508.457.2192 • procurement@whoi.edu

Last updated: April 1, 2013

Copyright ©2007 Woods Hole Oceanographic Institution, All Rights Reserved, Privacy Policy.
Problems or questions about the site, please contact webdev@whoi.edu
Contact Us | WHOI.edu Internal | Site Map | WHOI.edu External