VENDOR INFORMATION SHEET
New vendors with Howard Community College are required to provide the following information as well as a W-9 form.
PURCHASE ORDER ADDRESS:
Firm Name: _____________________________________________ Contact Name: ___________________________________________________________________
Federal Tax Identification or Social Security No.: ________________________________________________________________________________________
Street Address:
City, State, Zip Code:
Phone: Fax: Email:
REMITTANCE ADDRESS (if different than above):
Name:
Street Address:
City, State, Zip Code:
Phone: Fax: Email:
MINORITY OWNERSHIP (if applicable):
Is the company a certified Minority, Female, or Disabled-Owned Business Enterprise? _____ NO_____YES If “Yes”, please
answer a. and b.
a. Type of certification: _____African American _____Asian American _____Hispanic American
_____Female _____ Veteran
b. Name of Certifying Agency:
(ie., MDOT, City of Baltimore, Howard County, etc)
Certification Number: Expiration Date: ____________________________________
ORGANIZATION:
_____ Individual (Sole Proprietorship) _____ Wholesale Distributing
_____ Partnership _____ Manufacturing or Production
_____ Corporation _____ Retail Dealer
_____ Joint Venture _____ Service Organization
_____ Association _____ Contractor
_____ LLC/LPP _____ Other:
List category of products or services provided by your firm:
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Are your products green: ____ Yes ____No
CONFLICT OF INTEREST:
Does a current employee or trustee of the College own assets in this firm? _____ Yes ______No
Is a current employee or trustee of the College, a spouse, parent, child, or sibling of an owner of this firm? _____ Yes ______No
This form may be emailed to procurement@howardcc.edu or faxed to 443-518-4461
PLEASE REMEMBER TO ATTACH YOUR W-9 WHEN RETURNING THIS FORM
