Revised 9/2018
San Diego Community College District
Purchasing & Contract Services - 619-388-6562
http://bussrv.sdccd.edu/purchasing
SUPPLIER INTAKE FORM
This application must be submitted along with a completed and signed IRS W‐9 form for all new suppliers. Current IRS documents can be
found at: https://www.irs.gov/formspubs/aboutformw9
. Completed forms are required in order for a supplier to be added to the District’s
supplier database. Please complete the fields below and submit all documents to your District contact for processing.
To update an existing supplier, employee or student, indicate the changes below and submit to purchasing for approval. For a new Employee
or Student, use the Employee/Student’s ID number and add three leading zero’s (000xxxxxxx) to the number. Ensure that there are 10 digits.
NEW SUPPLIER EXISTING SUPPLIER EMPLOYEE STUDENT
SUPPLIER INFORMATION
Legal Business Name
Doing Business As
(DBA)
Individual/Sole Proprietor
First
M Last
MAILING ADDRESS
PAYMENT REMITTANCE ADDRESS
Change of address
C/O:
Address:
Address:
City:
State: Zip:
Phone: ( )
Same as mailing address
C/O:
Address:
Address:
City:
State: Zip:
Phone: ( )
Purchase Order Delivery Email Address
Description of Commodity/Transaction
Other
Are Your Products or Services Taxable in CA? Please Select the Appropriate Tax Classification
SUPPLIER’S PRIMARY CONTACT INFORMATION
Name
Phone
Title
Email
DIVERSITY BUSINESS ENTERPRISE INFORMATION
(TO BE COMPLETED BY SUPPLIERS ONLY)
Consistent with State Law, administrative regulations, and the District’s Equitable Opportunities
for Business Enterprise Program, a specific declaration to your business ownership status is required for the District’s reporting.
BUSINESS CATEGORY
ETHNICITY
Type of Contractor
Select if 8(a), MBE or selfcertified SDB
African American Asian American/Pacific Islander
Hispanic American Asian American (Subcontinent)
Native American Other
(American Indian, Eskimos,
Aleuts, or Native Hawaiians)
MBE/SDB/DBE Programs
Number of Employees
Average Revenue
(last 3 yrs)
VOSB
TO BE SIGNED BY AN SDCCD EMPLOYEE ONLY
SDCCD Employee: Name
and email address of the person to be notified by Purchasing when the supplier is approved.
NAME: DISTRICT EMAIL:
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