Nevada System of Higher Education
Business Center North  ▪  Purchasing Department
VENDOR APPLICATION FORM
To be processed as a vendor we also require that a W-9 form is completed and faxed to the Purchasing Department at 775-784-6017. The W 9 form is located on the Purchasing web site on the "FORMS" page

                                                                                                                                                        Federal Tax I.D. No.
Company name:          (FEIN or SSN)   

Address:      Phone:      

                       FAX: 
City                                                      State                                     Zip                                                                                                                                                                                                                                                                                                                E-mail:

Contact name:      Web:

___________________________________________________________________________________________________________

Remittance address if different than above:

 Name:     Department:

Address:      Phone: 

             FAX:
City                                                      State                                     Zip

___________________________________________________________________________________________________________

 Goods or services provided:  

 Standard payment terms:    Standard delivery terms:

 Check all appropriate categories:

Dealer         Manufacturer         Retailer          Individual          Sole proprietorship

Agent      Partnership     Corporation   Limited Liability Corp.      Other ________________________________________________________________________________________________________

TYPE OF BUSINESS:  (As established by the Federal Small Business Administration using criteria and standards in 13CFR121.) 
The data you provide should best describe the ownership of your business.
Choose One:          Large Business                  Small Business                     N/A

Choose One:          Woman-owned                 Male-owned                           N/A

Check all that apply:      HUBZone                  Veteran                   Service-Disabled Veteran

                   Socially & Economically Disadvantaged  (Asian-Americans, Asian-Pacific Americans,
 Black Americans, Hispanic Americans, Native Americans)_____________________________________________________________________________________________