Vendor Application Form Instructions
A W9 is required for all vendors before we can process the Vendor Application. Please
submit the W9 form along with the application.
1. Company Name and Address: Enter the vendor name and address exactly as it is shown
on the W9.
2. Address to which payments are to be mailed: Enter the company’s mailing address. If
same as # 1, leave blank.
3. Telephone (toll free): Enter the company’s toll free number.
4. Telephone (other): Enter the company’s number other than the toll free number.
5. Fax: Enter the company’s fax number – this is the number in which the purchase order
will be sent.
6. Name of Contact Person: Enter the name of the person who will serve as the company’s
general contact person.
7. Email Address of Contact Person: Enter the email address for the contact person listed
in #6.
8. Company URL: Enter the company’s internet address.
9. Federal Identification Number (FEIN): Enter your company’s federal identification
number as shown on the W9.
10. Social Security Number (if no FEIN): Enter individuals social security number if this is the
number listed on the W9.
11. Type of Organization: This information should be the same as reported on the W9 form.
Select ONE of the listed types of organizations that best describes the company. Also,
list the State of Incorporation and the Year of Incorporation.
12. Kind of Ownership (Check ALL that apply): This is information is required for reporting
purposes to the State of Tennessee. Select ALL that apply to your company.
13. Minority Ethnicity Code: This information is required for classification purposes to
satisfy purchasing and reporting requirements of the State of Tennessee. Select ONE of
the listed minority ethnicity codes that describe the company’s ownership.
14. Annual Gross Sales: This information is required for classification purposes to satisfy
purchasing and reporting requirements of the State of Tennessee. Please state the
company’s annual gross sales amount.
15. Type of Business: This information is required for classification purposes to satisfy
purchasing and reporting requirements of the State of Tennessee. Please select ONE of
the listed types of businesses that best describes the company.
16. Number of Employees: For classification purposes to satisfy purchasing and reporting
requirements of the State of Tennessee, this information is needed. Please specify the
number of employees currently employed with your company.
17. Excluded from Federal Procurement or Non-procurement Programs: Are you or any of
the principals of your company presently debarred, suspended, proposed for
debarment, declared ineligible or voluntarily excluded by any federal department
agency from participation in bid processes? Check yes or no
18. Preference for reporting purposes: This information is required for classification
purposes to satisfy purchasing and reporting requirements of the State of Tennessee.
Please select ONE of the listed ownership types preferred for reporting purposes.
19. Comments: List other information the company would like to provide.
20. Commodities: Please specify the commodities (goods and/or services) that are
available for purchase from the company. The list is provided on the Purchasing
webpage in which you will be routed when selecting “click here” on the application.
21. Certification: Sign and provide the information requested.
When application is complete, please email along with a W9 to
purchasing@roanestate.edu.