Section J-4, Delphi Vendor Form.docx
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- Attached to
- AMENDMENT #3 - DTFAWA-17-R-00007 - ADVANCED FLIGHT SAFETY AND SYSTEM SAFETY SUPPORT Federal contract opportunity
- Solicitation number
- DTFAWA-17-R-00007
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Section J-4, Delphi Vendor Form (docx)
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Text version
DELPHI VENDOR ENTRY WORKSHEET
Revised March 2016 – All Other Versions are Obsolete
** Bold/Yellow indicates a Required Fields **
CO/BUYER NAME:
| PHONE: - - |
| DATE: |
E-MAIL ADDRESS:
|_| New Supplier |_| Modifying Existing Supplier SUPPLIER NAME (As filed on IRS Form 1099):
DBA:
TAXPAYER ID:
DUNS or DUNS + 4: -
RESTRICTED FOR REAL ESTATE ONLY – LEASE?
|_| Yes |_| No
| GENERAL: |
| Parent Vendor Name: |
Parent Tax ID:
| CLASSIFICATION/TYPE: |
| |_| No Cost Lease/Award |_| Vendor |_| Federal Agency |
FEDERAL AGENCY LOCATION CODE (ALC) (* For New Agencies Only):
| ORGANIZATION TYPE: |
| |_| Corporation |
| |_| Foreign Corp/Government Agency/Individual/Partner |
| |_| Individual |
| |_| Reimbursable Non-Govt (Supplier/Grant Sponsor/State & |
Local Govt)
|_| Partnership
|_| Government Agency
IS VENDOR SAM REGISTERED (SEE SAM): |_| Yes |_| No
SUPPLIER SITES: (Additional Sites or Additional Tax Reporting Sites forward as an Attachment)
| |_| New Vendor |
| |_| Modifying Existing Site |
Supplier Number:
Supplier Site Name:
|_| Adding New Site
| Country: United States |
| Other: |
| Address: |
| City: |
| State: |
| County: |
| Zip Code: - |
| PAYMENT METHOD: |
| |_| Electronic |_| Check (Waiver Required) |
SITE USES: X Purchasing Site |_| Pay Site
TELEPHONE:
| Telephone Number: |
| - - |
| Facsimile Number: |
| - - |
BANKING INFO:
Bank Name:
Account Name:
Bank ABA Routing No:
Account Number:
Account Type:
|_| Checking |_| Savings
Scan and Email Form to: 9-AMC-KINTANA-Supplier-Setup@faa.gov
File details come from the government source that posted it. Updated .