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Iowa State University Vendor Registration
GENERAL INFORMATION:                                                                                                                                                                                                                  * Required fields
* Legal Business Name:
(as it appears on your tax return)
DBA Name:
(if different from Legal Name)
     * Fed ID Num
      
  - OR -
  
* Soc Sec Num
  
       DUNS #:
      
(Please do not enter dashes or spaces in the FEIN or SSN)
Order Address:
* Address 1 Address 2 * City * State * Zip
Remittance Address (if different from above):
Address 1 Address 2 City State Zip

* Phone #:
        Toll Free Phone #:
Fax #:

*Email Addresses:         
* Accepted Payment Methods: VISA Check Wire Transfer ACH
* Number of employees: * Gross annual revenue:
Internet Website:
BUSINESS ORGANIZATION: * If Corp:       If Sole Proprietorship:
      Owner's name on Social Security card
      BUSINESS PROFILE(check all that apply):
Manufacturer Wholesaler Retailer Service establishment
Construction concern Dealer Producer          Other
* One Product/Service required. Choose up to six.
     BUSINESS STATUS (check all that apply):
Rural Business Minority Owned (51% or more owned & managed by minority person(s)) Veteran Owned
Debarred vendor Federal small business (as defined by federal law) Disadvantaged business enterprise
8A Woman owned (51% or more owned & managed by women) Small disadvantage business enterprise
HUB Zone Located in Labor Surplus Area (as defined by Dept of Labor) Foreign Owned
Minority institution Disabled Owned (51% or more owned by disabled) Service-Disabled Veteran Owned
Majority Owned Certified by Iowa Targeted Small Business Non-profit organization
List applicable Standard Industrial Classification (SIC) codes if known:            
List applicable North American Industry Classification System (NAICS)codes if known:            
NOTICE TO CONTRACTORS: Iowa Law (Code of Iowa Chapter 91C) specified that all construction contractors utilized by state agencies must be registered with the Iowa
Contractor Registration Number is required before a state agency can award a contract. Registration forms are available from the Iowa Division of Labor at 1000 East 50319, (Phone: 515-242-5871).

(For non-corporations please upload your W-9 here if available)

* STATEMENT OF EMPLOYEE OWNERSHIP INTEREST:
If this registration is being submitted as an individual rather than under a business name, are you an Iowa State University employee, other Regent Institution employee, member of the Board of Regents, or State of Iowa state agency/department employee?
Is any other Regent institution, member of the Board of Regents, or State of Iowa state agency/department employee a partner in or sole proprietor of this business?
If you answer yes to any of these questions, the following conflict of interest (COI) information needs to be completed:
Name of COI person:
Relationship:
Name of Employing Agency:
* Person completing this form: