Vendor Application Form DIRECTIONS: Fill out this form as completely as possible. Forms that are incomplete will be discarded without notification. If you encounter an error, use the "Back" function in your browser to return to the form to correct it. Following the link on the error page will take you to a new copy of the form (without the data you have already entered--this is just like selecting "Start Over") I. Company Profile: Full Company Name: Acronym (if any) Email Address : Home Office Address: Address of Office Serving Flagler County School District: Sales Representative: Phone: Voice Mail: Fax: Address Orders are to be placed with: Inside Sales Rep : Phone: (800) Fax: Address invoices should be remitted to: Contact for billing problems: Phone: (800) Fax: Federal Employee ID No.: Payment Terms: Federal Tax ID No.: FOB Terms: (Flagler County School District pay terms are Net 45 days) Do you accept VISA Purchasing Cards? Yes No Do you have multiple locations, manufacturing sites, warehouses? Yes No Do you have state/government/e&i contracts we could take advantage of? Yes No Do you have your own delivery trucks? Yes No
What is your service, repair, returns policy? What is your standard delivery lead time? II. Company History: Primary Business Activity: Manufacturer Distributor Service Is your company a division or subsidiary of another company? No Yes If Yes, please explain Year company founded: Number of Full Time Employees Number of Part Time Employees List names(s) of owners(s); or if a corporation, the names and titles of company officers: Title: Title: Title: Title: Has the business or owner ever been in bankruptcy? No Yes If Yes, please explain Have you ever been on the Federal Banned Vendor List? No Yes If Yes, Please explain III. Product Information: List the principle products and services offered by your company: Please fax or mail brochures, line cards or additional company information, etc. IV. References: Please list three current customer references (colleges or universities preferred): Full school/company name: Address: Contact: Phone: Voice Mail: Fax:
Approximate annual sales: Full school/company name: Address: Contact: Phone: Voice Mail: Fax: Approximate annual sales: Full school/company name: Address: Contact: Phone: Voice Mail: Fax: Approximate annual sales: V. Financial Information: Bank Name: Address: Contact: Phone: Voice Mail: Fax: D&B # VI. Certification Under the guidelines established by the Small Business Administration, I certify that this company is a: Small Business Large Business Minority, Woman, or Disadvantaged-owned Business * If you are not an MWBE, do you do business with any MWBE organizations? Yes No
Signature: Title: Date: Select the category that best fits the description of your company type below. Athletics Athletic Equip Training Equip Video Technology Baseball Equip Basketball Equip Football Equip Gymnastics Equip Soccer Equip Softball Equip Track Equip Volleyball Equip Wrestling Equip Scoreboards Tape Uniforms Band Uniforms Cheerleading Choir Drill Team Maintenance Orchestra Food Services Appliances Beverages and Teas Breads and Snack Cakes Cash Registers Cleaning Supplies Coffee Dairy, Juice and Ice Dishwashing Supplies Grease Trap Service Ice Cream Ice Machines Large Equipment Non-Food and Paper Perishables Frozen Prime Vendor Produce Small Equipment Staples Vent-A-Hood Service
Furniture Art Room Career and Technology Lab Classroom Computer Early Childhood File Cabinets Food Court Library Modular Office Science Lab Study Carrels Wooden Instructional Art Supplies Audio Visual Equip Audio Visual Supplies Bulletin Boards Clinic Supplies Clocks Communication Equip Copiers Cosmetology Diplomas and Covers Early Childhood FAX Machines Flags Graphing Calculators Instructional Supplies Kilns Maps and Globes Marker boards Medical Equip Microscopes Music Equip Office Machines Office Supplies Paper Bond Paper Computer Paper Products Paper Products Photo ID System Photography Projection Screens Phys. Ed. Equipment Scanners and Forms
Kindergarten Supplies Laminating Film Laminating Machines Library Books Library Books Spanish Magazines Science Equip Senior Caps and Gowns Sewing Machines Stage Equip Teaching Supplies Vocational Equip Maintenance and Construction Asbestos Abatement Asphalt and Paving Athletic Fields Maint Auditorium Seating Bleacher Repair Blinds for Windows Cabinets Woodwork Cabling Carpet Carpet Installation Case Work Ceiling Tile and Grid Concrete Work Construction General Demolition Drainage Work Electrical Services Fire Alarm Systems Flooring Wood General Contractors Gym Floor HVAC Units Locker Painting Lockers Material Handling Equip Mats Mechanical Test/Balance Millwork Modular Buildings PA Systems Painting Parking Lot Lighting Personnel Lift Pest Control Projector Screens Refrigeration Equip
Fire Alarm Insp Repair Fire Restoration Fire Sprinkler Repair Floor Covering Safety Maintenance Construction Floor Tile Ceramic Floor Tile Floor Tile Installation Roofing Security Systems Shelving Stage Curtains Sweeper Tennis Crt Repairs Time Clock Service and Miscellaneous Architectural Eng Armored Car Audit Services Bar Coding Systems Book Repair Rebinding Cable Management CCTV Systems Cellular Phones Construction Mgmt Const Mgmt at Risk Consultant General Dumpster Service Electric Utilities Services Engineering Financial Services Gasoline Credit Cards Grad Announcements Ins Student Accident Ins Workers Comp Insurance Mailing Equipment Moving and Storage Pagers Portable Moving Printing Reclamation Equip Recycling Program Risk Management Roof Consultants Security Systems Senior Rings Senior Caps/Gowns Service Awards Testing (Air etc)
Ins 3rd Party Admin Ins Cafeteria Plans Ins Health Life Ins Property Casualty Ins Stop Loss Site Clean Up Vehicles Vending Machines Wheel Alignment Sys Yearbooks Supplies and Equipment AC Filters Batteries Bleachers and Repair Chemicals Agricultural Chemicals Cleaning Custodial Equipment Custodial Supplies Dock Equipment Fencing Materials Fertilization Field Light Fixtures Floor Finish Floor Machines Fork Lift Gauges Gloves Grass Trees Shrubs Grounds Equipment Irrigation Installation Irrigation Supplies Lamps and Ballast Landscaping Material Paper Towels and Tissues Parking Lot Striping Playground Equip. Playground Surface Plumbing Supplies Projector Bulbs Refrigeration Equip. Shop Equipment Soil Stabilization Sweepers Track Field Surfacing Tractors Trash Bags and Liners Two-Way Radios Vacuum Cleaners
Warehouse Equip. Technology Cabling CD Rom Computer Components Desktops Digital Cameras Disks Distance Learning Laptops Laser Printers Mainframe Media Retrieval Network Services Networking PDAs Peripherals Printer Cartridges QISV Qualified Scanners Software Video Conferencing Video Projection Systems Wiring