Company Name:
Company Address:
Federal ID Number or Social Security Number:
Address to which bidding forms and purchase orders are to be mailed:
Address to which payments are to be mailed:
Parent company and additional office locations in Michigan:
E-mail Address:
Web Address:
Type of Organization: Individual Partnership Corporation
Toll Free Telephone:
Primary Telephone:
Mobile Phone:
Fax:
Other Contact:
Persons to contact and those authorized to sign bids and contracts in your name (if agent, so specify)
Name:
Official Capacity:
Telephone No.:
Please complete the following:
Standard Payment Terms:
Prompt Pay Discount:
Standard Delivery Time:
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. Website address for NAICS is: https://www.census.gov/epcd/www/naics.html
Description:
CATEGORY (Check below the category which applies to the applicant)