FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Solicitation number
- 36C26226Q1202
About this file
This is a Vendor Information Form template used by the VA to collect and verify vendor registration details for federal contracting purposes.
The form requires vendors to provide comprehensive business information including requestor identification, vendor name, physical and mailing addresses, tax identification (TIN or SSN), contact information, and payment address. Section 11 addresses existing contracts, requesting contract numbers, beginning and expiration dates, FOB terms, and prompt payment discounts. The form classifies vendors by business type under FPDS standards (Small, Large, Outside VA, Other Entities) and captures socioeconomic status through checkboxes for designations such as Small Disadvantaged Business, Veteran-Owned Small Business, Woman-Owned Small Business, Hubzone Small Business, Historically Black Colleges/Universities, and Javits-Wagner-O'Day enrollees. Additional mandatory requirements include obtaining a Dun and Bradstreet Number and registering with Central Contractor Registration (CCR). Section 12 designates 1099 vendor status (always "YES" except for Federal Government entities), while Section 15 indicates whether vendors accept Purchase Card payment. The form concludes with verification requirements directing administrators to check two federal exclusion databases—http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/—before entering vendor information into the VA database to ensure vendor eligibility to conduct business with the Federal Government.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26226Q1202 0001.docx | DOCX document | |
| VA10091 Vendor Request Form.pdf | ||
| 36C26226Q1202_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 .