Demo Vendor Profile

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Coporate Headquarters
Payment and Remit
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Contact Information
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Geographical Service Area
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Region








if you select local, then select all the regions you serve
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Company Description
use keywords, describe the product lines/services your company provides
Financial Information
List the year and the gross annual sales figure associated
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Bonded

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Type of Ownership
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Business Ownership
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US citizen

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Business References (Top 3 Clients)
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Diversity
Are you a diverse supplier?

Minority, woman, veteran, LGBT, etc.
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Certifications

If you hold any of the certificates below you will need to provide them via email.

If yes, indicate your current certifications (choose all that apply)







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Quality and Enviornment Certifications
Indicate your current certifications (check all that apply)











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e.g. Microsoft MCSE, CPA, Series 7
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Extended Profile Information
Is your company union?

Do you have healthcare experience?

Construction companies only
Do you have a safety program?

Construction companies only
Manufacturers only
Does your organization handle or have access to patient protected confidential information (HIPPA)?

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Have you, your company or an employee been listed by a Federal agency as debarred, excluded or otherwise ineligible for participation in Federally funded healthcare programs?

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