Vendor Application

Vendor Application - Other

Please complete all required fields with a red asterisk, as well as any additional information you can provide.

Section 1 of 2

Vendor Information

Vendor Name*

Address Line 1*

Address Line 2

City*

State Code*

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Zip Code*

Country*

Vendor Type*

Please select a vendor type from the list below to identify your primary capabilities. Our team will use this internally when sourcing vendors.

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Contact Name*

Phone Number*

Contact Email Address*

Website

EIN*

Minority Owned*

If yes, please attach a certificate

Yes

Women Owned*

If yes, please attach a certificate

Yes

W-9

Please attach your W-9 and check this box to indicate the upload is complete.

W-8-BENE (International Vendors only)

Please attached your W-8 and check this box to indicate the upload is complete.

CIMA CONTACT - How did you here about us?*

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Additional Info. & Description of Services Provided

File Attachments

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