Vendor Registration
In accordance with the Illinois Public Act 102-0265, the Village of Lake Bluff is required to make a good faith effort to collect and publish certain demographic information provided by our vendors and subcontractors. The Village is now required to report whether a vendor or subcontractor is a minority, women, or veteran-owned business as defined by Illinois Law. In addition, the Village is required to disclose if the business is certified as a small business under Small Business Administration standards. Please complete the following form. Contact information will not be published.
Company Name
Company Name (as shown on Tax Return)
DBA Name (if different from Tax Return)
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Information
Contact Name
Title
Phone Number
Format: (000) 000-0000.
Email Address
Please indicate your classification indicators as defined in the Business Enterprise for Minorities, Women, and Persons with Disabilities Act (select all that apply):
Minority-Owned Business
Women-Owned Business
Veteran-Owned Business
None of the Above
For your selected classification categories, does your business hold any certifications or are you self-certifying?:
Yes (official certification held)
No
Self-Certifying
Not Applicable
Apply
Should be Empty: