FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26226Q0038
About this file
This document is a Vendor Information form used by the Veterans Affairs (VA) department to collect comprehensive details about potential vendors. The form requires vendors to provide key information including business contact details, tax identification, existing contracts, business type, and socioeconomic classifications. Critical mandatory requirements include obtaining a D-U-N-S number, registering with Central Contractor Registration (CCR), and verifying eligibility to do business with the federal government by checking specific exclusion websites.
The form captures detailed vendor characteristics, including business size (small, large, or other), socioeconomic group designations such as Small Disadvantaged Business, Veteran-Owned, Woman-Owned, and HUBZone Small Business. Additional vendor payment and contract information is collected, such as purchase card acceptance, prompt payment discounts, and existing contract details. Vendors must also indicate their 1099 status and provide contact information, with mandatory verification steps to ensure compliance with federal contracting regulations before being entered into the VA database.
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Other files
| File | Type | Posted |
|---|---|---|
| Additional Questions and Answers.docx | DOCX document | |
| 36C26226Q0038 - Question and Answers.docx | DOCX document | |
| 0003 - Amendment - Card Reader.docx | DOCX document | |
| 36C26226Q0038 0002.pdf | ||
| P0001 - Amendment Card Reader.pdf | ||
| VA10091.pdf | ||
| S02 - 36C26226Q0038 - Card Reader.pdf | ||
| 36C26226Q0038_1.docx | DOCX document | |
| W-9 Form.pdf |
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Text version
VENDOR INFORMATION
1. REQUESTOR:
2. SERVICE:
3. EXTENSION:
4. VENDOR NAME:
Doing Business As/Legal Name:
5. VENDOR ADDRESS
Physical Location:
Mailing Address:
City:
State/Zip:
6. VENDOR TAX IDENTIFICATION NO. or
SOCIAL SECURITY NUMBER:
(Mandatory field must enter one or the other)
TIN:
SSN:
7. VENDOR PHONE & FAX NUMBER:
Phone:
Fax:
Email: :
8. PAYMENT STREET ADDRESS:
Address:
City:
State/Zip:
9. POINT OF CONTACT:
10. ACCOUNT NUMBER:
11. Does Vendor have an existing contract? YES NO If answer is YES, please enter Contract Number:
(i.e. GS-, V797 or any other contract with payment terms N/30 and expiration date) Beginning Date: Expiration Date:
FOB: Destination Origin Prompt Payment Discount: _________ (i.e. 2%/10; 1%/20 or N/30)
12. 1099 Vendor Indicator: YES (Always YES except if FEDERAL Government) NO
13. Business Type (FPDS) (Must check one): Small Large Outside VA Other Entities
14. Socioeconomic Group: (Please check all that apply) Sm Disadvantage Bus Javits-Wagner-O’Day Hubzone Small Business Veteran-Owned Small Bus Woman-Owned Small Business Historically Black College & Univ./Min Institute Veteran-Owned Large Bus Woman-Owned Large Business None of the other business Veteran-Service Disabled
15. Purchase Card Accepted YES NO
16. DUN and BRADSTREET NUMBER: ___________________________ (Mandatory-if vendor does not have one they need to go to http://www.dnb.com to register.
17. Is Vendor registered with Central Contractor Registration (CCR)? YES NO (Mandatory-if vendor is not registered they can accomplish the task at: http://www.ccr.gov to register.
18. Before we may enter any new vendor information within the VA database the mandatory registration sites shall be checked along with the status of the vendor’s ability to do business within the Federal Government. Failure to check the mandatory field(s) could result in administrative action. The following two sites are your final check .
http://epls.arnet.gov/ & http://exclusions.oig.hhs.gov/
File details come from the government source that posted it. Updated .