INFO_SHEET.docx

INFORMATIONAL SHEET

PLEASE INCLUDE THE FOLLOWING INFORMATION WITH YOUR QUOTE. IF ANY ITEMS ARE NOT APPLICABLE, SO STATE.

CONTRACTOR NAME: _______________________________________________

EXPIRATION DATE: ______________________________________________

MAX ORDER LIMIT: ______________________________________________

FOB: __________________________________________________________

PROMPT PAYMENT: _______________________________________________

DELIVERY TIME: ________________________________________________

WARRANTY: _____________________________________________________

Y2K COMPLIANT: ________________________________________________

CAGE CODE: ____________________________________________________

FEDERAL TAX ID (TIN): _________________________________________

DUNS NUMBER: __________________________________________________

BUSINESS SIZE: ________________________________________________

MAILING ADDRESS: ______________________________________________

REMIT TO ADDRESS: _____________________________________________

(If different from mailing _____________________________________________ address)

BILLING INCREMENT Monthly Quarterly Annually Other (Circle One)

CONTRACTOR POC: ________________________________________________

POC TELEPHONE NO.: ____________________________________________

POC FAX NO.: __________________________________________________

POC E-MAIL ADDRESS: ___________________________________________

DO YOU ACCEPT THE GOVERNMENT IMPAC CREDIT CARD? _______________

ARE YOU REGISTERED IN CCR: ____________________________________