Portal

Vendor Information Form

Sauk Valley Community College Contact Person

Business Name or Name of Individual*

Parent Company Name*

Address Line 1:*

Address Line 2:

City:*

State:*

Zipcode:*

Mailing Address
For bid specs, orders, contracts, etc.

Address Line 1:*

Address Line 2:

City:*

State:*

Zipcode:*

Payment Address
If different from Mailing Address

Website

Contract Type

Name*

Phone Number*

Email*

Certified Minority Business Enterprise (MBE)

Certified Female Business Enterprise (FBE)

Certified Persons with Disabilities Business Enterprise (PBE)

Certified Small Business Enterprise (SBE)

Certified Veteran-Owned Business (VOB)

Sheltered Workshops (SWS)

MBE, FBE, PBE, SBE and VOB CERTIFICATION (optional, if applicable)

If you checked any of these boxes, you are required to submit a current letter of certification with this application.

African American

Hispanic

Asian

American Indian

Other

Ethnicity

Other Ethnicity

Tax Information

Corporation

Sole Proprietorship

Limited Liability Company (LLC)

Partnership

Other

Tax Structure

Other Tax Structure

Tax Reporting Name

You are required to submit a completed W-9 with this application.

Commodities (List types of products and services provided)

Vendor Terms & Signature

All purchasing must follow the laws of the State of Illinois and the Illinois Public Community College Act as well as Board Policy of Sauk Valley Community College.

I hereby certify that the information supplied herein is correct. I understand that misrepresentation may be cause for removal from the qualified vendor list and any other penalties allowed by law.

If any of the vendor information on this form changes, the vendor must complete a new form indicating “Existing Vendor Information Update.”

Vendor Terms

Signature*

Title*

W9 Information

Taxpayer ID*