CMS Vendor Application

CMS Vendor Application

Complete all 6 drop-down sections below.

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- 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?
- Full Legal Name*
  
  First NameMiddle NameLast NameSuffix
- DBA (Doing Business As) Name*
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  
  Area CodePhone Number
- Fax Number
  
  Area CodePhone Number
- Email Address*
  example@example.com
- Website Address
- Full Legal Name*
  
  First NameMiddle NameLast NameSuffix
- DBA (Doing Business As) Name*
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  
  Area CodePhone Number
- Fax Number
  
  Area CodePhone Number
- Email Address*
  example@example.com
- Website Address
- Federal Tax Identification Number*
- Are you a CMS employee?*
  
  YesNo
- Are you a 1099 vendor?*
  
  YesNo
- Are you a subsidiary of a parent company?*
  
  YesNo
- If so, who is the parent company?
- 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.
- Attach Your SIGNED W9 Form Here (REQUIRED)*
  
  Browse Files
  DID YOU SIGN YOUR W-9? Applications with unsigned W9 forms cannot be processed. File types accepted: pdf, doc, xls, jpg, png Cancelof
- 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
- Should be Empty: