Become a Vendor Application

Become a Vendor Application
Please sign and complete an IRS W-9 Form, you'll be asked to upload it in this application.
Business Name*
(if individual, please enter full name below)

First NameLast Name
Street or P.O. Box address to which bid requests are to be mailed:*

Mailing Street Address

Address Line 2

CityState

Zip Code
Phone Number*
Best phone number to reach you
E-mail *
example@example.com

Contact
Is there a specific contact person that receives the bid request via e-mail?*

YesNo
Please provide contact person information to whom bid requests via mail.*

First NameLast Name
Phone Number*
Best phone number to reach you
E-mail *
example@example.com

About the Business
Is your business incorporated?

YesNo
Date of Incorporation

MonthDayYear
Date
State where it was incorporated
Is previous address the main business address?

YesNo
Please enter the business main address

Street Address

Street Address Line 2

CityState

Zip Code
Do you have a principle factory or warehouse ?

FactoryWarehouse
Location of principal factory or warehouse:
Do you currently hold any Florida State contracts?

YesNo
If you currently hold any Florida State contracts, list contract numbers and expiration dates
What is your principal line of business?
How long in present business?

Bidder’s Comments
The undersigned hereby certifies that the above and foregoing information is a full, true, and correct statement of the facts. It is understood that failure to bid or return the proper no bid form on three (3) consecutive bid invitations for any given Commodity Class could result in removal from the Bidder's mailing list for that Class.

Please check the application to ensure that a correct response has been made to each question. Any omissions will result in follow-up inquiry and may delay your entry onto our vendor list.
By typing my name in the below space, I am electronically signing this form. By signing this electronic signature certifies the information to be true, accurate, and complete.*

First NameLast Name
Should be Empty: