Ppd Vendor Set Up Form

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Vendor Set-up Form
Vendor Information
Name:
Business name, if different from above:
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Check appropriate box:
Individual/Sole Proprietor
Corporation
Partnership
Exempt from backup withholding
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Other ___________________
Address (number, street, sand apt. or suite no.):
City, State, and Zip code:
Contact person:
Phone:
Fax:
Email:
Website (URL):
Remit to address (if different from above):
City, State, and Zip code:
Contact person:
Phone:
E-mail:
Taxpayer Identification
Taxpayer Identification # (TIN):
Social Security SSN # (please provide if no TIN is available):
Business Classification Information
In accordance with the SBA requirements
Please Check appropriate box if applicable:
Please Check appropriate box if applicable:
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Small Business (SB) CCR #) ______________
Large Business
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Woman Owned (WOSB)
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Minority Owned (SDB)
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Veteran Owned (VOSB)
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Disabled Veteran Owned (DVOSB)
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Service Disabled Veteran-Owned Small Business (SDVOSB)
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HUB Zone Qualified Business
Government Interactions
Will this vendor interact with government officials on our behalf?
If YES, then Corporate Purchasing will need to send the PPD Third-
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Party Representative And Vendor Due Diligence Questionnaire to the
Yes
No
vendor for completion, returned to PPD, and reviewed PRIOR to
engagement.

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