Vendor Registry Form

Marymount University requires all vendors and suppliers to complete this form and supply the appropriate documents to be considered to do business with the University.

Legal Name *

Tax Classification*

Legal Physical Mailing Address - Provide street, city, state and zip code *

Alternate Name or Address (if applicable) - Provide any alternate and circumstances it should be used

Contact name(s) - List primary contact(s). First and Last name on each line. *

Contact Email(s). Please list each email on a different line. *

Business Phone Number (including area code)*

Is your business a provider of GOODS ?*

YesNo

Is your business a provider of SERVICES?*

YesNo

Description of GOODS or SERVICES offered - Example: IT Services, Cleaning Services, Lab supplies, Office supplies, Software, Marketing Items, Vehicles, etc

NAICS Code (if applicable)

Is your business a MINORITY OWNED Business?*

YesNo

If Yes, please choose

Is your business a DISABLED VETERAN OWNED Business ?*

YesNo

Is your business a SMALL DISADVANTAGED Business?*

YesNo

Is your business a WOMEN OWNED Business?*

YesNo

Is your business a VETERAN OWNED Business?*

YesNo