Vendor Profile and Classification Form
 
 
 
 
Vendor Profile
 
 
 
 
Vendor Name*
 
 
 
 
DBA
 
 
 
 
Federal Tax ID #
 
 
 
 
Address
 
 
 
 
City
 
 
 
 
State/Province
 
 
 
 
Zip Code
 
 
 
 
Phone Number
 
 
 
 
Contact Name*
 
 
 
 
Email Address*
 
 
 
 
 
 
 
Type of Business:
 
 
 
 
 
Individual/Sole Proprietor
 
 
 
 
Corporation
 
 
 
 
Partnership
 
 
 
 
Other
 
 
 
 
 
 
 
Vendor Classification
 
 
 
 
 
Business Size:
 
 
 
 
 
Small Business (As Defined by SBA)
 
 
 
Large Business
 
 
 
 
 
 
Small Business Categories (check all that apply):
 
 
 
 
Women owned Business Enterprise
 
 
 
Minority Business Enterprise
 
 
 
LGBT owned Business Enterprise
 
 
 
Service-Disabled Veteran Enterprise
 
 
 
HUBZone Small Business
 
 
 
Veteran-owned Enterprise
 
 
 
None of the Above
 
 
 
Other
 
 
 
 
 
 
 
Note: Please attach a copy of certification if your company is certified by the following organizations: Small Business Administration, National Minority Suppliers Development Council (NMSDC), Women's Business Enterprise National Council (WBENC) or National Gay & Lesbian Chamber of Commerce (NGLCC) Department of General Services (Veteran Business Only). 
 
 
 
Attach certification here (if applicable)
 
 
 
 
 
 
Is your business minority owned?
 
 
 
 
Black / African American
 
 
 
American Indian / Alaska Native
 
 
 
Hispanic / Latino
 
 
 
Nat. Hawaiian / Other
 
 
 
Pacific Asian
 
 
 
Indian Asian
 
 
 
Pacific Islanders
 
 
 
2 or more Races
 
 
 
 
 
 
If you are not a Women-Owned Business Enterprise or a Minority Business Enterprise or an LGBT owned Business Enterprise, do you have a diversity policy? 
 
 
 
Yes
 
 
 
 
No
 
 
 
 
 
 
 
If yes, what percentage of your business goes to qualifying businesses? (%)
 
 
 
 
 
 
 
If yes, what dollar value of your business goes to qualifying businesses? ($)
 
 
 
 
 
 
 
Are figures: 
 
 
 
 
 
Actual
 
 
 
 
Estimates
 
 
 
 
 
 
 
Completed By:
 
 
 
 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
Job Title*
 
 
 
 
Date*