Become a Vendor

Vendor Data Sheet
(All Supplier, see insurance requirements below)**
Business Name*
Website
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Type of Ownership*
- Corporation
- Partnership
- Limited Partnership
- Sole Proprietorship
- Joint Proprietorship
If Minority, What Status?
- Black
- Hispanic
- American Indian
- Alaskan Native
- Women
- Asian American
- MBE Certified
Tax ID#*
Business Description*
(type of business, service, or product)
Principals
Principals in the Company
Name Title (Owner, Partner, President, etc) Phone
References
Business Contract References
Name Title Address Phone
Title*
Date*
Authorized Signature*
**Before commencing work the CONTRACTOR shall furnish HACB with certificates of insurance showing that the insurance is in force and will insure all operations under negotiated Agreement, and name HACB as an additional insured. Further information can be obtained from the Procurement Officer by email nicholaspa@bmtha.org.
Name
This field is for validation purposes and should be left unchanged.

Name	Title (Owner, Partner, President, etc)	Phone

Name	Title	Address	Phone

Vendor Data Sheet