Company Name Address Line 1 Address Line 2 Phone | Fax email	YOUR LOGO
COMPANY CONTACT	VENDOR REGISTRATION FORM
COMPANY NAME	MAILING ADDRESS
TELEPHONE
FAX
EMAIL	WEBSITE
POINT OF CONTACT NAME & TITLE	CONTACT EMAIL
CONTACT PHONE 1	CONTACT PHONE 2
COMPANY OVERVIEW
GENERAL DETAILS OF SERVICES / GOODS
DATE COMPANY ESTABLISHED	GROSS ANNUAL SALES
GEOGRAPHIC SERVICE AREA	LEGAL STRUCTURE
BUSINESS TYPE	YEARS PREVIOUSLY REGISTERED
INSURED?	BONDED?
LICENSED?	LICENSE NUMBER
ADDITIONAL INFO
BANKING INFORMATION
BANK NAME	BANK ADDRESS
BENEFICIARY NAME
ACCOUNT NUMBER
CERTIFICATION
I hereby affirm that all information supplied is true and accurate to the best of my knowledge and belief, and I understand that this information will be considered material in the evaluation of quotations, bids, and proposals. Notice must be given of any change in status impacting the information provided within ten (10) days of said change.
PRINTED / TYPED NAME	TITLE
SIGNATURE	DATE

VENDOR REGISTRATION FORM TEMPLATE

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