Vendor Registration Form (Finance)

Vendor Registration Form

Phone: 314-989-8150 l www.ssdmo.org
Welcome to Special School District of St. Louis County's Vendor Registration site. This form should be completed by an individual with the authority to enter into business contracts.
Date of Submission

MonthDayYear
Date Form Completed
Hour MinutesAM/PM Option
Company Information
Company Name*
Contact Name*

First Name Last Name
Business Address*
City*
State*
Zip Code*
Phone Number*
Format: (000) 000-0000.
Email Address*
Website
YesNo
Secondary Contact Name
Secondary Email Address
example@ssd.org
Services
ConsultantContractorServiceSupplyOther
Brief Summary of Services
Entity Ownership
Sole ProprietorCorporationPartnershipNon-profitLimited Liability CompanyOther
Federal Employer ID or SSN*
W-9 Date*

MonthDayYear
Date
W-9 Upload*

Cancelof
Insurance Expiration Date*

MonthDayYear
Date
Insurance Documentation Upload*

Cancelof
MBE/WBE/BDE/SDVE Certifications

Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE), and Service-Disabled Veteran Business Enterprise (SDVE)
Minority Business Enterprise (MBE)Women Business Enterprise (WBE)Disadvantaged Business Enterprise (DBE)Service-Disabled Veteran Business Enterprise (SDVE)Not ApplicableOther
State or Locality Certification Number*
Enter N/A if not applicable.
Other Certification
Enter N/A if not applicable.
Should be Empty:

Vendor Registration Form