FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Solicitation number
- 36C26226Q0498
About this file
This is a Vendor Information form used by the VA (Department of Veterans Affairs) to collect and validate vendor registration data for federal contracting purposes.
The form captures essential vendor identification and business information required for VA database entry, including vendor name, physical and mailing addresses, tax identification number or Social Security number, phone, fax, email, payment address, and point of contact. It requests information about existing contracts, including contract numbers, beginning and expiration dates, FOB terms, and prompt payment discount arrangements. The form requires vendors to indicate their business type (Small, Large, Outside VA, or Other Entities) and socioeconomic status across multiple categories including small disadvantaged business, veteran-owned small or large business, woman-owned small or large business, HUBZone small business, and historically black colleges and universities or minority institutions. Additional required fields include 1099 vendor indicator status, Dun and Bradstreet number, Central Contractor Registration (CCR) status, and purchase card acceptance capability. The form mandates verification of vendor registration at three federal databases prior to entering vendor information into the VA system: CCR.gov, http://epls.arnet.gov/, and http://exclusions.oig.hhs.gov/. This validation ensures vendors are eligible to conduct business with the federal government and have no debarment or exclusion issues.
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Other files
| File | Type | Posted |
|---|---|---|
| VA10091 Vendor Request Form.pdf | ||
| 36C26226Q0498_1.docx | DOCX document | |
| W9 Request for Taxpayer Identification Number and Certification.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 .