3c Exhibit 3 - WBSCM Vendor Registration Form.pdf

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Welcome to Supplier Self-registration

If you would like to do business with USDA, please complete and submit the following form.

* - Required Field.

Company Details

Type of Vendor

Are you a US-based Vendor?

Are you registered with System for Award Management?

Enter DUNS Number * Enter Tax Payer ID(TIN) * Enter Foreign ID * Address Data Business Types Non-Certified Certified Business Types Non-Certified Certified Which Product/Service Categories do you Offer?

Organization Type Data Privacy Statement USDA Data Privacy Statement The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information identified on this Website is 7 CFR Part 1400. The information will be used to evaluate bids to purchase commodities and provide services. The information collected may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated). Providing the requested information is voluntary. However, failure to furnish the requested information will result in non-consideration. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.

USDA WBSCM Team Phone: 1-877-WBSCM-4U Email: wbscm.servicedesk@caci.com Note :

* Check whether the form is completely filled using the Check button

* Once completed save and mail it to the Email address provided in the Form.

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DUNS_ID:
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