FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Attached to
- J043--UTILITY AIR COMPPRESSOR Replacement and Installation -w/wd POP 3/30/2026 - 9/30/2026
- Solicitation number
- 36C26226Q0431
About this file
This is a Vendor Information Form used by the VA (Department of Veterans Affairs) for registering and maintaining vendor data in the federal contracting database. The form captures essential vendor identification and business information required for federal procurement purposes.
The form requires vendors to provide basic identification details including requestor information, vendor legal name, doing business as name, physical and mailing addresses, and contact information. Mandatory fields include either a Tax Identification Number (TIN) or Social Security Number (SSN), a Dun and Bradstreet Number, and proof of Central Contractor Registration (CCR) enrollment. Vendors must also specify payment street address, point of contact, and account number. The form requires vendors to disclose whether they hold an existing contract with payment terms and expiration dates, indicate if they accept purchase cards, and state their preferred Free on Board (FOB) terms and prompt payment discount rates.
The form includes classification fields for business type under the Federal Procurement Data System (FPDS)—designating vendors as Small, Large, Outside VA, or Other Entities—and socioeconomic status categories including small disadvantaged businesses, veteran-owned businesses (both small and large), women-owned businesses, Hubzone small businesses, and historically black colleges and universities. A mandatory 1099 Vendor Indicator field applies to all vendors except federal government entities. Before vendor information is entered into the VA database, administrators must verify the vendor's eligibility through two mandatory federal exclusion databases: the Excluded Parties List System (EPLS) and the HHS Office of Inspector General exclusions list.
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Other files
| File | Type | Posted |
|---|---|---|
| W9 Request for Taxpayer Identification Number and Certification.pdf | ||
| VA10091 Vendor Request Form.pdf | ||
| 36C26226Q0431_1.docx | DOCX document |
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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 .