New Vendor Information Form

*Indicates required field.

*Registration Date:
*Company Name:	D/B/A (If applicable);

*Business Address:

Suite / Floor / PO Box:

*Company Phone No.:

*City:

*State:

*Zip Code:

*Website:

Remittance Address (if different than business):

Suite / Floor / PO Box:

City:

State:

Zip Code:

*Contact Last Name:

*First Name:

*Title:

Office Phone:

Mobile Phone:

Fax Number:

*Federal Tax ID No. (EIN) or Social Security No.:

*Email Address:

* Individual

Sole Proprietor

Corporation

Partnership

Other:

*Proof of Insurance (required for service providers)

Yes

No (NOT APPLICABLE)

*What are the main goods/services your Company provides?

Your Company is a:	Your company provides services/supplies in the field of:
Manufacturer Supplier Professional Service Broker Other Services	Construction Electrical Plumbing Hardware Building-Maintenance	Mechanical Transportation Info Tech. Special Equipment
Other:	Other:

Please list all of your Company's NAICS, NGIP, SIC, CSI and/or UN/SPC Codes:

MINORITY/WOMEN BUSINESS ENTERPRISE (MBE/WBE)

Is your Company at least 51% Minority-Owned?	Yes	No
Ethnicity of Ownership:	African-American	Hispanic	Asian-American;
Is your Company at least 51% Female-Owned?	Yes	No
Is your company certified or pending certification as an MBE or WBE?	Yes	No

Indicate and provide a copy of your MBE/WBE certification. McCormick Place SMG will recognize certification from cities, states, counties and other certification entities that have standardized procedures verifying that a company is 51% owned by a minority or woman. This is subject to review and approval by McCormick Place/SMG.

Attach a document
(*file must be .docx or .pdf and be 10MB or smaller)

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