Vendor Application

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New Vendor Existing Vendor (change in information)

Legal Name of Company (as recorded with the IRS) *

Doing Business As (DBA) Name of Company * Same as legal name

Tax ID Type *

SSNFEINOther

Tax ID Number *

Corporation Partnership Individual / Sole Proprietor Non Profit

Providing Service Providing Product

MCPSS Employee Requesting Application

Employee First Name *

Employee Last Name *

School / Department *

Employee Email Address *

Street Address *

City *

State *

ZIP *

Telephone

Fax

Email Address for Purchase Orders

Address used for: Bids Purchase Order Remittance

Street Address

City

State

ZIP

Telephone

Fax

Address used for: Bids Purchase Order Remittance

I hereby certify that the information contained herein is correct and that I understand that any misrepresentation of information could cause cancellation by the Mobile County Public School System. I certify that I will not discriminate against any employee or applicant for employment because of race, color, religion, sex, disability, national origin, age or marital status. I further certify that neither the applicant nor any person in any connection with the applicant as a principal or officer, so far as is known, is not debarred or otherwise declared ineligible by any federally funded program or agency, or by the Mobile County Public School System, from bidding for furnishing materials, supplies or services to any agency thereof.

I have read and agree to the certification above. *

Name of Person Signing *

Date *

Title *

W-9 Attachment *

Need a W-9? Download a fillable W-9 form.

Mobile County Public Schools

Mobile County Public Schools Bid Portal