Preferred Vendor Application

To participate in the Preferred Vendor Program, a business must be at least fifty-one percent (51%) owned, operated and controlled by one or more minority individuals with US citizenship.

*Minority Category:
 
*Company Name:
Parent Company:
 
 
Physical Address:
*Address Line 1:
Address Line 2:
*City:
*State:
*ZIP Code:
Physical address is home office

 
 
Mailing Address:Same as Physical Address
*Address Line 1:
Address Line 2:
*City:
*State:
*ZIP Code:
 
 
*Phone:
Fax:
Website:
*Email:
*Key Contact(s) Name:
*Key Contact's Title:
Employer's Federal Tax ID#:
(numbers only, no dashes)
SSN (for Indv Only):
(numbers only, no dashes)
 

*Owners/Stakeholder
Please list each owner, proprietor, partner, officer, member, director and stockholder. The name listed should include Minority Group Members and Non-Minority Group Members.

Name Title Minority Group Gender Years of
Ownership
Ownership Role Ownership
Percentage
Voting
Percentage

*Key Individuals
Identify those individuals (owners, non-owners and key employees) who are responsible for the day-to-day operations and policy decision-making, including those with prime responsibilities for:

Operation Name Title
Financial Decisions
Signatory on Major Documents
Accounts Receivable
Marketing/Sales
Estimating/Bids
Supervision of Field Operations