VENDOR REGISTRATION APPLICATION - Cochise College

Cochise College
Purchasing Department
4190 W. State Highway 80
Douglas, AZ 85607
Cochise College Use Only
Vendor#: _____________________
1099: No Yes (copy to AP)
This information will appear on our Purchase Orders
VENDOR REGISTRATION APPLICATION
Vendor Name _____________________________________________________________________________________
Address __________________________________________________________________________________________
City _________________________________________ State___________________ Zip Code____________________
Contact Person___________________________________________Title______________________________________
Phone#_______________________________Fax#_____________________________Alt#_______________________
E-mail______________________________________________Website_______________________________________
Send Payment to Address (if different from information above)
Vendor Name _____________________________________________________________________________________
Address __________________________________________________________________________________________
City _________________________________________ State___________________ Zip Code____________________
Contact Person___________________________________________Title______________________________________
Phone#_______________________________Fax#_____________________________Alt#_______________________
E-mail______________________________________________Website_______________________________________
Tax Information
Please note: This vendor registration will not be considered by Cochise College without the following information.
Does your company collect Arizona Sales Tax Yes No
If you are an out of state vendor, does your company have nexus with the State of Arizona Yes No
If you answered “Yes” to either question please provide the following information:
Arizona Sales Tax # (Transaction Privilege Tax#) ______________________and sales or use tax rate charged __________%
ALL VENDORS ARE REQUESTED TO SUBMIT A COMPLETED W-9 FORM
(Request for Tax Payer Identification Number and Certification) ALONG WITH THIS APPLICATION
Foreign persons who are non-residents for US Tax purposes do not complete a W-9.
You will need to complete IRS Form W-8 available at http://www.irs.gov and return with this form.
To the best of your knowledge are you or anyone at your organization related to a faculty or staff member of Cochise
College Yes No If Yes, please list college employee name(s) ___________________________________________________
Business Classification Information
Mark all that apply
Women-Owned
Minority-Owned
Veteran-Owned
Small/Disadvantaged
Non-Profit
Public Utility
Foreign___________
Manufacturer
Wholesaler
Distributor
Contractor
Retailer
Service
Other _____________
Continue on other side
Updated 2/2011

Commodity Code Categories
(Please check all that apply to your organization)
Advertising/ Marketing
Agriculture Products & Services
Appraisal Services
Architectural Services
Art Equipment & Supplies
Athletic Equipment & Supplies
Auctioning Services
Audio Visual Equipment & Supplies
Automotive (all types)
Aviation (all types)
Buildings Equipment & Supplies
Building Rental
Clothing & Apparel
Communications
Computer (all types)
Consulting Services
Construction Management
Construction Equipment & Supplies
Courier/Delivery Services
Custodial Supplies & Services
Educational Services
Engineering Services
Equipment Rental
Financial Services
Food Service
Furniture (all types)
Hazardous Materials Services
Grounds Equipment & Supplies
Instructional & Library Products
Insurance Services
Laboratory/Medical Equipment & Supplies
Laundry/Dry Cleaning
Legal Services
Moving Services
Office Equipment & Supplies
Outdoor Equipment & Services
Pest Control
Printing Products & Services
Promotional Products & Services
Restaurant Equipment & Supplies
Security, Fire, Safety & Emergency Services
Trash Removal
Travel: Agencies, Charter Services,
Hotel/Motel Accommodations
Vending Machine Services
Other
_______________________________________
_______________________________________
Vendor Requirements
In order to remain a qualified vendor of Cochise College I agree to the following:
a. All orders must have a valid purchase order number or valid Purchasing Card.
b. All orders must be sent directly to the “Ship To” address on the purchase order or P-card order.
c. All invoices must reference a valid purchase order number.
d. All invoices must be submitted directly to: Accounts Payable Department
4190 W. Hwy 80
Douglas, AZ 85607
e. All order inquiries must be directed to the Purchasing Department at the address, phone or fax listed below.
Application Certification
By signing, the vendor agrees to the above requirements and the following:
1. I am duly authorized to certify the information requested herein.
2. To the best of my knowledge, the information provided herein is accurate and true as of this date.
3. I understand this form supplies information only and does not constitute an assumed obligation by Cochise
College to guarantee contractual awards or agreements to my organization.
4. I understand it is our responsibility to advise the Purchasing Department in writing of any changes of
information (i.e. address, contact name, numbers etc.) on this form.
Authorized Signature____________________________________________ Date ____________________________
Print Name ___________________________________________ Title ______________________________________
Return Form to: Cochise College
Questions Contact us:
Purchasing Department By phone: 800-966-7943 ext. 4047 / 4125
4190 W. Hwy 80 By fax: 520-417-4141
Douglas, AZ 85607
By e-mail: purchasing@cochise.edu
Updated 2/2011