Tenn Tech Univ - Purchasing Vendor Registration Form

Tennessee Board of Regents
Higher Education System
Vendor Application Form

Complete all information and submit for inclusion
of your company for invitations to bid from:

Tennessee Technological University
Purchasing Office
P.O. Box 5041
Cookeville, TN 38505
http://www.tntech.edu/purchasing

Click here for Instructions Page or on a question for further instruction or explanation

1. Company Name & Bid Address

Name:
Street:
Street2:

City:

State:

Zip:

2. Address to which payments are to be mailed (if same as #1, leave blank)

Name:
Street:
Street2:

City:

State:

Zip:

3. Telephone (toll free)

4. Telephone (other)

5. Fax

6. Name of Contact Person

7. Email Address of Contact Person

8. Company URL

9. Federal Identification Number (FEIN)

10. Social Security Number (if no FEIN)

11. Type of Organization

State of Incorporation

Year of Incorporation

12. Kind of Ownership (Check all that apply)

Govt. (GO)	Minority
Non-Profit (NO)	Woman (WO)
Majority (MJ)	Small (SM)

13. Minority Ethnicity Code

14. Annual Gross Sales

15. Type of Business

16. Number of Employees

17. Excluded from Federal Procurement or Nonprocurement Programs? Yes No

18. Preference for reporting purposes
Small Minority Woman-Owned None

19. Comments:

20. Commodities: Please provide the 5-digit commodity codes for goods and/or services (click here) for which your company would like to be provided bid opportunities. If additional space is needed to enter commodities, please note in the comments section of the vendor application.

Code Sub-Code	Code Sub-Code	Code Sub-Code	Code Sub-Code	Code Sub-Code	Code Sub-Code

21. Certification: By submitting this form, I certify that I am an authorized representative of the above company and that all the information as completed above is true and accurate.


Name	Title	Date