University of Maine Vendor Application


This is an electronic application that will be sent to the Purchasing Department at the University of Maine. Please fill out the following information.

COMPANY INFORMATION

Company Name :                      Telephone # :

Physical Address :                        Facsimile # :

City : State : Zip Code :


Federal Employer Identification Number :

Social Security Number (if an individual) :


CONTACT

OWNER

           Name :

Official Title :

          E-mail :

          Name:

Official Title:

         E-mail :


Company's Current General Liability Insurance Coverage:


COMMODITY INTEREST SELECTION

1st Choice :

2nd Choice :

3rd Choice :


DEMOGRAPHIC INFORMATION

                                                      Business Type : 

                                                Organization Type : 

                                                              Ethnicity : 

                                             Business Ownership : 

Do you agree to, and understand, all of the conditions, laws, and regulations required for bidding? Yes No

AFFIDAVIT

By submitting this application, I do hereby solemnly swear or affirm that the information given above is current and true to the best of my knowledge and is in no way misleading. Furthermore, should any data change in the future, I will ensure that correct information will immediately be submitted to the University of Maine Purchasing Department. I also hereby certify that no officer, owner, or employee having a substantial part of capital interest in the above named firm is also an official or employee of any budget unit of the University of Maine. I agree to furnish any and all materials and supplies in strict accordance with all conditions imposed.


Created April 10, 1996 // Last Modified August 9, 2004

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The University of Maine , Orono, Maine 04469
207-581-1110
A Member of the University of Maine System