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* denotes a required form field     This form should ONLY be filled out if your company qualifies as a certified Minority Business Enterprise (MBE) and/or Women Business Enterprise (WBE). All other vendors: please contact us at (407) 245-4000.         Business Information: (Note: If you are an existing vendor, please click here) Business Name:* Federal ID Number:*   SIC Number:* (SIC number found on your operational license) Owner Title: First Name:* Owner Last Name:* Contact Title: First Name:* Contact Last Name:* Address Line 1:* Address Line 2: Address City: * Address State:* (choose) AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Address Zip: * Telephone:* Ext   Fax #:   Mobile #: Email Address: * Web Site Address: Business Type:* (choose) Broker Distributor Manufacturer Manufacturer's Representative Service Date Established: * (MM/DD/YYYY) Geographic Service Area:* (choose) International National Regional Local Service Area Type: N/A Number of Employees:* Number of Minority Employees:* Product/Services:* Annual Sales: * (no commas or dollar signs) $         Darden Information:     Vendor Type: Accounts Payable Small Business:* Yes No Woman Owned: * Yes No Minority Owned: * Yes No Ethnicity: ( * required if Minority-Owned) (choose) African American Asian Indian American Asian Pacific American Hispanic American Native American Certified: ( * required if Woman- or Minority-Owned) Yes No By which entity: ( * required if Woman or Minority-Owned) Certification Date: ( * required if Woman- or Minority-Owned) (MM/DD/YYYY) Certification Expire Date: ( * required if Woman- or Minority-Owned) (MM/DD/YYYY) Member NMSDC:* www.nmsdc.org Yes No Member WBENC:* www.wbenc.org Yes No Category:* (choose) CEP Design and Construction Distribution/Logistics Finance General Services Human Resources IT Internal Audit Legal Marketing Media & Communications Purchasing Security Smallwares Other Corporate Department Purchasing Corporate Purchasing Operations Purchasing Sub-Category:* N/A         Company Officers:     1.Title:    First Name:*  Last Name: * Job Title:* Percent Ownership:* %         2.Title:    First Name:  Last Name: Job Title: Percent Ownership: %         3.Title:    First Name:  Last Name: Job Title: Percent Ownership: %                 Company References:     1. Client Company: Telephone:    Ext: Contact Title: First Name: Contact Last Name:  Job Title:             2. Client Company: Telephone:    Ext: Contact Title: First Name: Contact Last Name:  Job Title:             3. Client Company: Telephone:    Ext: Contact Title: First Name:  Contact Last Name:  Job Title:

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