FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Attached to
- J063--Install Intercom Speakers in Onyx Clinic -w/wd Fitara Not Required POP 12/21/2025-9/30/2026
- Solicitation number
- 36C26226Q0145
About this file
This is a Vendor Information form used by the Department of Veterans Affairs (VA) to collect comprehensive details about a potential vendor. The form requires vendors to provide key business information including contact details, tax identification, business type, socioeconomic classification, and registration status. Mandatory fields cover vendor name, address, phone numbers, tax ID or social security number, existing contract details, and registration with Central Contractor Registration (CCR).
The form also captures important vendor classifications such as business size (small, large), socioeconomic groups (including small disadvantaged business, veteran-owned, woman-owned), and payment terms. Vendors must verify their eligibility to do business with the federal government by checking specific websites like http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/. The form requires vendors to have a D-U-N-S number and indicates whether purchase cards are accepted, providing a comprehensive profile for potential VA contracting opportunities.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26226Q0145_1.docx | DOCX document | |
| W-9 Form.pdf | ||
| VA10091.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 .