QMAA-FK-160009-D_Request_for_AutoBid_Account_07_21_2016.docx

U.S. General Services Administration

2017 Wheelchair Accessible Light Vehicles Ordering Program GSA Solicitation QMAA-FK-160009-D Request for AutoBid Account

Company Information Please complete the following fields required to create an AutoBid account for this announcement:

Company Name

Address

Address (if necessary)

Address (City/State/Zip)

Valid DUNS number

Business Size (Large/Small)

User #1 Request Name

Telephone Number

Fax Number

Email

User #2 Request (if applicable) Name

Telephone Number

Fax Number

Email

User #3 Request (if applicable) Name

Telephone Number

Fax Number

Email

User #4 Request (if applicable) Name

Telephone Number

Fax Number

Email

Requested Vehicle Makes Please review the “Anticipated Items” document posted with the Synopsis, and check the appropriate box(es) below to identify the vehicle makes requested for AutoBid account access:

|_| Daimler Vans

|_| FCA US LLC

|_| Ford |_| Honda |_| Mobility Ventures |_| Toyota

To electronically check a box, double-click on the selected box. When prompted, change the value from “Not Checked” to “Checked” and select OK. Screenshot below:

Submission Please submit electronically completed form to the following address:

automotiveedi.partnerships@gsa.gov 1800 F Street NW Washington, DC 20405 www.gsa.gov image1.png image2.png