Required_Information.doc

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WALTER MACHINE COOLERS
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HSCG40-15-Q-50260
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REQUIRED VENDOR INFORMATION

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USCG SURFACE FORCES LOGISTICS CENTER

2401 HAWKINS POINT ROAD

BALTIMORE, MD 21226-5000

410-762-6508(phone) 410-762-6570(fax) Kim.j.wooters@uscg.mil

PLEASE QUOTE DELIVERED PRICE

1. SIZE OF BUSINESS _________SMALL ________LARGE

2. PAYMENT TERMS______________________________________________

3. COMMERCIAL ITEM (sold, leased or licensed to the general public)____YES____NO

4. AVAILABILITY ________________DAY / WEEKS ARO

5. GOVT CREDIT CARD ACCEPTED _______YES ______NO

6. POINT OF CONTACT ____________________________________________

DIRECT PHONE NUMBER FOR POC _________________________________

7. TAXPAYER ID#________________________ (REQUIRED)

8. DUNS#_______________________________ (REQUIRED)

9. VENDOR ADDRESS _____________________________________________

CITY, STATE, ZIP ______________________________________________

10. FREIGHT COST/S&H TERMS ______________________________________

11. GSA CONTRACT # ____________________________________________

SAMS REGISTRATION ________________YES _________NO (SAMS(WWW.SAMS.GOV) REGISTRATION IS REQUIRED)

SHIP TO ADDRESS: SURFACE FORCES LOGISTICS CENTER

RECEIVING ROOM BLDG. 88

2401 HAWKINS POINT RD

BALTIMORE, MD 21226

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