36C25818Q9828-003.docx
DOCX document 56 KB Posted
- Attached to
- FBO - RFQ - 36C25818Q9828 - BD Diagnostic Instruments PM Solicitation Extended Due to East Coast Hurricane Delays This will ensure all interested quoters will be afforded time to submit an offer for the posted solicitation. Federal contract opportunity
- Solicitation number
- 36C25818Q9828
About this file
36C25818Q9828 VA Form 10091.docx
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25818Q9828-004.docx | DOCX document | |
| 36C25818Q9828-002.docx | DOCX document | |
| 36C25818Q9828-001.docx | DOCX document | |
| 36C25818Q9828-000.docx | DOCX document |
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Text version
FMS VENDOR FILE REQUEST FORM
NEW UPDATE
VA FACILITY INFORMATION
STATION NUMBER
STATION CONTACT
STATION PHONE NUMBER STATION FAX NUMBER
STATION EMAIL ADDRESS
PAYEE/VENDOR INFORMATION
COMMERCIAL VENDOR REGISTERED IN SAM.GOV
(Required IAW FAR 4.1102)
DUNS NUMBER
DUNS+4
SSN/TIN
PAYEE/VENDOR TYPE (Select one)
C - COMMERCIAL E - EMPLOYEE
F - FEDERAL AGENCY FACTS ID
O - FOREIGN
NPI
SMALL BUSINESS - VENDOR MUST BE QUALIFIED AS SMALL BUSINESS IN
I - INDIVIDUAL/HONORARIUM
V - VETERAN MISCELLANEOUS ACTIONS (Select one)
A - AGENT CASHIER U - UTILITY
VENDOR NAME
DBA
SAM OR FURNISH SBA CONFIRMATION
| WINRS | ASSIGNMENT (All applicable documents) |
| BILL OF COLLECTIONS | SETTLEMENT/TORTS ALAC/LGY ACCOUNT # |
FOR QUESTIONS REGARDING THIS FORM:
NVF CONTACT INFORMATION
NATIONWIDE VENDOR FILE CUSTOMER SERVICE: EMAIL:
VAFSCVENDOT@VA.GOV
FOR ALL OTHER INQUIRIES:
CUSTOMER CARE CENTER: 1-877-353-9791 STATION CARE CENTER: 1-866-372-1141
SUBMIT ALL DOCUMENTATION VIA: SECURE FAX: 512-460-5221
CONTACT
EMAIL ADDRESS
PHONE NUMBER
CURRENT ADDRESSS (Include Street, City, State and Zip Code)
PREVIOUS ADDRESSS (Include Street, City, State and Zip Code)
EFT/ACH (Required IAW 31 CFR Part 208)
BANK NAME
BANK ADDRESSS (Include City, State and Zip Code)
NINE-DIGIT BANK ROUTING NUMBER
ACCOUNT NUMBER
ACCOUNT TYPE
CHECKING SAVINGS
PAYEE/VENDOR PRINTED NAME & TITLE
SIGNATURE
VA FORM APR 2014
10091
NORMAL PROCESSING TIME IS 3 - 5 BUSINESS DAYS. WE DO NOT ACCEPT INVOICES
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