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Vendor Application

 

 

VENDOR APPLICATION

Please provide all information that applies.

Submit this form with a signed copy of your W9.


The vendor is responsible to contact DUSD with any updates or changes.

Questions? Contact Pruchasing Specialist, Celina Ybarra at

(520) 364-2447 ext. 7004.


COMPLETE AND RETURN TO:

cybarra@douglasschools.org


Douglas Unified School District No. 27

Purchasing Department

1132 12th Street

Douglas, Arizona 85607

 

GENERAL VENDOR INFORMATION

NAME OF VENDOR:      

DBA (if applicable):      

Street Address:      

City:      

State:      

Zip Code:      

Main Business Phone #:      

Website:      

Federal Tax ID or SSN #:      

DUNS No. #:      

Tax Classification: ? Individual/Sole Proprietor  ? Corporation ? LLC (C) ? LLC (S) ? LLC (P) ? Non-Profit

 

PURCHASE ORDER INFORMATION

Does Your Organization Accept Purchase Orders: ?Yes*  ?No *by indicating YES, vendor agrees to Net 30 terms and understands payment will not be issued until services/goods are received, and an invoice is provided to the DUSD Accounts Payable Department.

Business Name on Purchase Order:      

Order Address:      

City:      

State:      

Zip Code:      

Vendor Order Phone #:      

 

Vendor Order Email:      

 

PAYMENT AND INVOICE

INFORMATION

Pay to the Order of:      

Remittance Address:      

City:      

State:      

Zip Code:      

Accounting Contact:      

Accounting Phone:      

Accounting Email:      

 

USE TAX

DETERMINATION

 

Do you have an Arizona Transaction Privilege Tax License? ?Yes  ?No

( If Yes, #:              )

Does your organization have a physical Arizona Location?  ?Yes ?No

Does your organization provide goods, services, or both?   ?Goods ?Services ?Both

 

COOPERATIVE PURCHASING:

(Check all that apply and  indicate award number for each contract)


? Mohave #                 ? S.A.V.E. #                 ? 1GPA #                 ? National IPA #             


? State of Arizona #                     ? US Communities #                 ? Other #         

  

 

VENDOR DISCLOSURES:

?Yes  ?No Are you an employee of DUSD? If yes, a conflict of interest form must be on file.            

?Yes  ?No Are you a relative of a DUSD employee? If yes, who?          

 

By signing below, I certify all information is true and correct to the best of my knowledge.

Printed Name:      

Title:      

Signature:      

Date:      

 

If you would like to be on the DUSD Bidders List, please register at http://www.dusd.k12.az.us/

The Douglas Unified School District #27 does not discriminate on the basis of race, color, national origin, sex, age, religion or disability.
El Distrito Escolar Unificado de Douglas #27 no discrimina sobre la base de raza, color, origen nacional, sexo, edad, religiĆ³n o discapacidad.

SCHOOLinSITES
1132 E 12th St
Douglas, AZ 85607
Phone (520) 364-2447
Fax (520) 224-2430
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Copyright © 2018
Douglas Unified School District 27