CMS Vendor Application

CMS Vendor Application

Complete all 6 drop-down sections below.

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1. Complete CMS Contact Info
CMS Staff Member Contact*

First NameLast Name
CMS Staff Contact Telephone Number*

Area CodePhone Number
CMS Staff Contact Email Address*
example@example.com
CMS Department or School*
Type of Request*

Add New VendorAdd New Address for Existing VendorChange NameChange Address for Existing Vendor
Are you a food vendor?*

YesNo
If yes, what if your Health Permit Number?

4. Complete HUB Information
Which Historically Underutilized Business (HUB) do you qualify for?*

Minority-OwnedWomen-OwnedDisabled-OwnedDisabled-Owned Business EnterpriseNon-Profit Work Center for Blind and Severly DisabledN/A (not applicable)
To qualify for a Minority Business Enterprise status, 51% of your business must be owned and controlled by a minority group, woman, or the disabled. For the purpose of this definition, Minority Business Enterprise members are African Americans, Hispanic Americans, Native Americans, Asian Pacific, or Asian Indians, American Women and/or the Disabled. To qualify for a Disabled Business Enterprise status, you must be a non-profit entity whose main purpose is to provide ongoing habilitation/rehabilitation, independent living, and competitive employment for persons who are handicapped through supported employment sites or business operated to provide training and employment and competitive wages. If you qualify for one or more classification(s), please check all the appropriate blocks. If you do not qualify, please check the block marked N/A.

5. Attach Your W9 Form Here
Attach Your SIGNED W9 Form Here (REQUIRED)*

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DID YOU SIGN YOUR W-9? Applications with unsigned W9 forms cannot be processed. File types accepted: pdf, doc, xls, jpg, png Cancelof

6. Complete and Sign Application
Applicant Certification

By submitting this application, I do hereby solemnly swear or affirm that the information given in this application is true to the best of my knowledge and is in no way misleading. I also certify that I nor my company upon which this application is submitted have any officer, agent, manager, teacher or employee affiliation with The Charlotte-Mecklenburg Board of Education, nor any pecuniary interest, either directly or indirectly, proximately or remotely in supplying any goods or services to the Charlotte-Mecklenburg Board of Education.
This Form Was Completed By...*

First NameLast Name
Job Title*
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Applicant Signature*

Clear
Please sign the form to the best of your ability using your mouse.
Date*

MonthDayYear
Date
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