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VENDOR/SUPPLIER PREQUALIFICATION
Vendor/Supplier Prequalification Form
silmanservices-com
2020-02-27T04:19:46+00:00
PARTNER PORTAL
Vendor / Supplier
Prequalification Form
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1
2
Are you already working with SilMan?
*
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No
Who is your SilMan Team Member contact?
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Last
Company Name (including DBA)
*
Primary Contact
*
First
Last
Email
*
Office Phone (Main)
Mobile Phone
*
Fax
Address
*
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Zip Code
Do you offer delivery services, if requested?
*
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AR Primary Contact
*
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AR Email
*
AR Phone
*
Remit To Address:
*
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Does your business have any Federal, State, or Local Program Designations or Certifications?
Yes
No
If yes, check all that apply.
Disabled Owned
Disabled Veteran Business Enterprise (DVBE)
Disadvantaged Business Enterprise (DBE)
Disadvantaged Veteran Enterprise (DVE)
HUBZone Certified
Minority Business Enterprise (MBE)
Service-Disabled Veteran (SDV)
Small Business
Small Disadvantaged Business (SDB)
Veteran Business Enterprise (VBE)
Woman Business Enterprise (WBE)
8(A) Designation
Other (list below)
If "Other" was selected above, please list below.
Upload copies of Federal, State and Local Programs, Designations, and Certifications.
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Date
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Submittal Items
W-9 IRS Form (current Request for Taxpayer Identification Number and Certification)
*
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You can upload up to 6 files.
You may also provide other relevant documents. For example, COLI (name SilMan Industries as insured), awards/recognition, etc.
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