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Supplier Application Form

How is my information used?

Thank you for submitting your company's profile for our consideration. It will be added to a master database of potential suppliers to Vanderbilt University and reviewed within 45 working days by our sourcing staff who will then contact you.

The submission of your profile does not automatically grant you approved supplier status with Vanderbilt University. Procurement Services uses this database to find potential new suppliers to meet the expressed needs of our higher education, research and patient care customers.

If we are interested in doing business with your company, you will be contacted by the Sourcing Officer who handles your commodity. All small business and diversity-owned companies are also asked to register with the SBA.

Note: Once submitted, data will be searchable for 3 years.

Company Overview Information:

* Company Name:
* Address 1:
Address 2:
* City: * State: * Zipcode:
* Phone #:
* Fax #:
Url (web address):
Remit-to address: (If different than main address)

* Principal's Name:
* Principal's Title:

Contact Information:

* Contact Name:
Contact Title:
* Contact email:
* Contact phone:
Contact fax:

Membership Information

Are you currently a member of any of the following organizations? Nashville Chamber of Commerce:
Tennessee Minority Purchasing Council:
Tennessee Business Travelers Association:
Other:
 

Company Details

* Type of Business:
* Legal Structure:
Number of years in business:
* Gross Annual Sales Last Fiscal Yr: $
* Approx. Num of Employees:
* Primary Commodity:
Other Commodity(s):
(hold ctrl while selecting to choose multiple commodities)
* Products/Services (details):
CCR number:
Electronic data capabilities:
* ISO 9000 Registered?
* ISO 14000 Registered?
* W-9 form available?
 

Diverse Classification

* Diversity Status: (Check any that apply)
Small Business
Small Disadvantaged Business
Veteran-Owned
Minority-Owned
Disabled-Owned
Women-Owned
HUBZone Certified
8a
Other:
Certifying agency:
 

References

Please include: Company Name, Contact, Address, and Phone# for each.
Reference 1:
 
Reference 2:
 
Reference 3:
 

Prior Contact

Have you done any business with Vanderbilt in the previous three years? If so, please list the department and Vanderbilt person you worked with.
Have you already been in contact with Procurement Services about opportunities at Vanderbilt? If so, please list the Vanderbilt person you are working with approximate last date you were in contact.
(i.e. John Smith - June 2012)

* By signing below I certify that the submitted information is accurate and true.
Authorizing Signature:
Title: