Bid Attachments

Description

LANSING SCHOOL DISTRICT PURCHASING DEPARTMENT 519 W. KALAMAZOO ST., ROOM 200 LANSING MI 48933 (517) 755-3030 FAX (517) 755-3019 PURFR016 – 7/7/08 – Version 5 MARK ONE:
New Application
Update Date: SUPPLIER/VENDOR APPLICATION (Please type or print) W-9 form attached? DUN & BRADSTREET RATING (if available) FEDERAL ID NUMBER NAME OF COMPANY (OR)
YES
NO SOCIAL SECURITY NUMBER Submit copy of W-9 form with application ADDRESS TO WHICH BIDDING FORMS AND PURCHASE ORDERS ARE TO BE MAILED – STREET NO., CITY, STATE, ZIP CODE ADDRESS TO WHICH PAYMENTS ARE TO BE MAILED – STREET NO., CITY, STATE, ZIP CODE PARENT COMPANY AND ADDITIONAL OFFICE LOCATIONS IN MICHIGAN (May attach separate sheet) E-MAIL ADDRESS: WEB SITE: For Purchase orders to be emailed TELEPHONE #: TYPE OF ORGANIZATION
Individual
Partnership
Corporation FACSIMILIE #: PERSONS TO CONTACT AND THOSE AUTHORIZED TO SIGN BIDS AND CONTRACTS IN YOUR NAME (if agent, so specify) Name Official Capacity Telephone No. PLEASE LIST ON THE REVERSE SIDE CLASSES OF EQUIPMENT, SUPPLIES, MATERIALS, AND/OR SERVICES ON WHICH YOU DESIRE TO BID.
Do you require a hard copy of verbal orders? Yes No Do you accept Procurement Cards? Yes No
Electronic Disk Catalog □ Electronic Ordering Please complete the following: STANDARD PAYMENT TERMS: PROMPT PAY DISCOUNT: STANDARD DELIVERY TIME: PLEASE COMPLETE BELOW Please list percentage and circle category that applies: MINORITY OWNED: WOMEN OWNED: % Native-American Asian-Pacific American African-American Hispanic-American Asian-Indian American % White Native-American Asian-Pacific American African-American Hispanic-American Asian-Indian American DISABLED: % SMALL BUSINESS: Yes Business located within LANSING SCHOOL District Yes Are you certified? If so, list agencies SIGNATURE OF PERSON AUTHORIZED TO SIGN THIS APPLICATION NAME AND TITLE OF PERSON SIGNING (Please type or print) No No Certificate Number: COMMODITY LIST Please place a checkmark (√) by the appropriate code and provide a detailed description of the commodities and/or services offered. If the complete NAICS Code is known please include this number in the description area.