The University of Toledo : Supplier Registration Form

Company Information * - required

Company Name:*
Street Address 1:*
Street Address 2:
City:*	State:* Zip:*
Phone Number:*
Toll Free Number:
Fax:
Company Website:
Name of Sales Rep:*
Rep Phone:*	Extension:
Rep Email:
Request for Proposal/Bid Information
Name of Recipient:*
Recipient's Email:

Is your company (choose if applicable)

	Certified Encouraging Diversity, Growth and Equity (EDGE) by State of Ohio
	Certified Minority Business Enterprise (MBE) by State of Ohio, Section 125 ORC.
	Certified Small Disadvantaged Business (SDB) by SBA
	Veteran Owned
Affiliated with any Group Purchasing Organization
	(AEPA/OCEPC) Ohio Council of Educational Purchasing Consortia
	(E&I) Educational & Instructional Cooperative Purchasing
	(IUC) Inter-University Council Purchasing Group of Ohio
	(MTEPA) Metropolitan Toledo Educational Purchasing Association
	(NJPA) National Joint Powers Alliance
	(STS) State Term Schedule of Ohio
	LERC/Amerinet
	UHC/Novation
	US Communities
	Other

Select one or more commodity/service

	Appliances	Includes refrigerators, freezers, TVs, washers, dryers, etc.
	Athletic or Recreational Equipment, Supplies or Services	Includes sports equipment & apparel, track and field, exercise machines, etc.
	Audio/Visual Equipment, Supplies or Services	Includes projectors, TVs, broadcasting equipment, cameras, etc.
	Computers & Peripheral Equipment, Supplies or Services	Includes all hardware, software, printers, toner/ink cartridges, maintenance agreements, etc.
	Construction or Renovation Supplies or Services	Includes all trades, carpeting, window treatments, etc.
	Consultant or Professional Services	Includes lecturers, architects, moving services, insurance carriers, pest control, freight carrier, window washers, etc.
	Electronic Supplies	Includes circuit boards, resistors, gauges, etc.
	Financial Services	Includes leasing, financing capital, etc.
	Food Service Equipment, Supplies or Services	Includes all food related goods or services
	Furniture (Academic/Business/Medical)	Includes office, dorm, hospital beds, lounge, children's, cafeteria furniture, etc.
	Library/Educational Equipment or Supplies	Includes books, carts, detection services, etc.
	Maintenance (Building) Equipment, Supplies or Services	Includes janitorial, lighting, material handling, uniforms, safety shoes, etc.
	Maintenance (Grounds) Equipment, Supplies or Services	Includes parking lot paving, sealing, snow removal, lawn care or chemicals, fencing, etc.
	Medical Equipment, Supplies or Services	Includes hospital, operating room, anesthesia, biomedical equipment, cardiology vascular lab, dialysis, endoscopy, radiology, respiratory, sterile processing supplies, etc.
	Motorized Vehicles	Includes the purchase of new motorized vehicles, shop equipment, repairs/body work, etc.
	Musical Instruments, Supplies or Services	Includes band instruments, band uniforms, piano's, etc.
	Office Supplies, Equipment or Services	Includes general supplies, fax machines, copiers, mailroom equipment, paper, etc.
	Pharmacy Supplies or Services	Drugs, labels, forms, solutions, etc.
	Printing Services	Includes printers of books, publications, magazines, forms, etc.
	Promotional Supplies or Services	Includes screen printing, embroidered apparel, etc.
	Safety or Protection Equipment, Supplies or Services	Includes crowd control, security related goods/services, tent rentals, etc.
	Scientific Equipment, Supplies or Services	Includes lab/research equipment, gasses, glassware, measurement equipment, etc.
	Signage Equipment or Supplies	Includes building signs, directional signs, etc.
	Telecommunication Equipment, Supplies or Services	Includes telephones, cell phones, pagers, long distance services, prepaid phone cards, 2 way radios, etc.
	Textiles, Laundry Equipment, Supplies or Services	Includes towels, linens, washers, dryers, laundry/dry cleaning services, etc.
	University Travel	Includes travel agents, hotel reservations, car/bus/van rentals, air charters, etc.
	Waste Removal	Includes solid, laboratory, asbestos, hazardous, etc.
	Other

List specific commodity or services you are interested in providing:

Authorization

Terms of Registration: By submitting this registration form, you are authorizing The University of Toledo to add your company information to our database for future purchase consideration. You certify that all information provided is accurate and reliable; your company is not suspended or debarred by the Federal Government or the State of Ohio from participating in Federal or State funded projects; have not been sanctioned by or excluded from participation in any federal or state health care program, including Medicare and Medicaid; and that no conflict of interest exists or will exist as a result of your participation as a University of Toledo supplier. You understand that submission of this form is voluntary and does not "guarantee" future business with The University of Toledo.
Name of Authorized Representative:*
Email:*
Title:*
Phone:*

Purchasing : Supplier Registration Form