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Want to Be a Supplier?

Sherri Zone
Procurement Manager

Completion of this form is required to establish your company as an authorized vendor in DS&S Automated System.

MASTER VENDOR FORM

  * denotes required
* Product/Service to be provided: A value is required.
   

SALES OFFICE ADDRESS (for mailing/correspondence related to Purchase Orders)
*Full Legal Name of Business:
DBA:
*Street Address:
Street Address:
*City:
*State:
County:
*Zip Code:
Country
*Phone Number:
Alternate Phone Number:
Fax Number:
*Salesperson Name:
*Salesperson Email:: A value is required.Invalid format.
   

REMITTANCE ADDRESS (for mailing/correspondence related to Payments)
Name to Appear on Checks:
Street Address:
Street Address:
City:
State:
County:
Zip Code:
A/R Contact Name:
Phone Number:
Alternate Phone Number:
Fax Number:
   

SOCIO-ECONOMIC STATUS (based on primary SIC/MCC Code) - Check All That Apply
A - Small Business B - Small Disadvantaged Business
C - Women Owned Business D - Large Business
E - Education Institution F - Foreign Owned Business
G - Government Agency H - Historically Black College
I - Minority Educational Institution J - Large Disadvantaged Business
K - Non-Profit Organization L - Labor Surplus Area
   

TERMS OF PAYMENT
Net 45 days from receipt of invoice
REQUEST FOR TAXPAYER ID NUMBER & CERTIFICATION (Substitute W-9) - It is MANDATORY to indicate Social Security Number (SSN) or Federal Tax ID Number (TIN) for your type of organization below:
Individual/Sole-proprietorship (provide S.S.N.)
Corporation (provide TIN)
Vendor is a Partnership (provide TIN)
Other type of organization
(describe)

**CERTIFICATION:

Certification Required Under penalties of perjury, I certify that the number shown on this form is my correct T.I.N. and I am not subject to backup withholding because: I am exempt from backup withholding
Enter Text Below: