Vendor Application Form

Applicant

Legal Name of Company

Type of organization (select one)

Year Business Started

If Incorporated, Which State

Year Incorporated

Address to which bidding forms and purchase orders are to be mailed

Street

City

State

Zip Code

Address to which payments are to be mailed

Street

City

State

Zip Code

Contact

Phone Number

(Include area code)
1-123-456-7890
Please hover over the question mark to see more acceptable phone number examples.

Fax Number

For quotes, PO's, & addenda (include area code)
1-123-456-7890
Please hover over the question mark to see more acceptable fax number examples.
If no fax number available, please enter 999-999-9999

E-mail address (Business Purpose Only)

Your email must be in myuser@domain.com format. It must end with .com, .net, .org, .edu, .us, or .gov

Names of Officers, Members, or Owners of Concern, Partnership, Etc.

President

Vice-President

Secretary

Treasurer

Owner(s) or Partner(s)

Affirmative Action

If your firm is a veteran and/or minority-owned business entity (MBE), woman-owned business entity (WBE), or a small business entity (as defined by the SBA), please indicate your status (check all that apply)

VBE - Veteran-owned Business Entity

MBE - Minority-owned Business Entity

WBE - Woman-owned Business Entity

SBE - Small Business Entity (as defined by the SBA)

MWB - Minority and Woman owned Business Entity

MVE - Minority and Veteran owned Business Entity

WVE - Woman and Veteran owned Business Entity

MWV - Minority, Woman and Veteran owned Business Entity

The District’s Affirmative Action Office will contact you for further information regarding your status

Company Details

Number of Persons Currently Employed

Amount of Stock in Own Warehouse

Net Worth $

As of Date

Please click on the entry box below to select NIGP codes which most closely match the supplies, equipment, and services on which you desire to bid.

To select numerous NIGP codes, simply re-click on the entry box below. You can also search by typing in keywords.

To select numerous NIGP codes, simply hold control (Ctrl) key on your keyboard while clicking on other NIGP codes.

Authorized Agent

I certify that the information supplied herein (including all pages attached) is correct and that neither the applicant nor any person (or concern) in any connection with the applicant is a principal or officer, so far as is known, is now debarred or otherwise declared ineligible by any public agency from bidding for furnishing materials, supplies, or services to any agency thereof.

Name

Title

Signature (Please use your cursor to sign in the signature box below)

Sign above.

Help

If you're having difficulty with this online form, please download the Vendor Application Form. The form needs to be filled out in its entirety. Upon completion it can then be either mailed or faxed to us.

Metropolitan Water Reclamation District of Greater Chicago
Department of Procurement and Materials Management
5th Floor
100 E Erie
Chicago, IL 60611

Fax: (312) 751-3042

Phone: (312) 751-6643

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