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VENDOR APPLICATION

(CHECK ONE) INDIVIDUAL SOLE PROPRIETOR PARTNERSHIP CORPORATION LLC LLP

Full Company and/or Individual Name

PH # Fax #

FEDERAL I.D.# EMAIL ADDRESS:

HOW LONG IN BUSINESS UNDER CURRENT NAME? YEAR(S) MONTH(S)

OFFICE LOCATION:

COMPANY/INDIVIDUAL BANK ACCOUNT WITH:

LOAN OFFICER/BANKER NAME:

ACCOUNT NO.

PHONE #: BUILDERÕS/TRADE LICENSE #: DRIVERÕS LICENSE #:

PERSON(S) AUTHORIZED TO SIGN: DRIVERS LICENSE #:

PURCHASE ORDERS REQUIRED: YES NO

NO. OF FIELD EMPLOYEES: NO. OF OFFICE STAFF: NO. OF PROJECT MANAGERS:

PRINCIPALS OF COMPANY

NAME:

TITLE:

SOC. SECURTIY NO. BIRTH DATE:

HOME ADDRESS:

CITY: STATE: ZIP CODE:

NAME:

TITLE:

SOC. SECURTIY NO. BIRTH DATE:

HOME ADDRESS:

CITY: STATE: ZIP CODE:

NAME:

TITLE:

SOC. SECURTIY NO. BIRTH DATE:

HOME ADDRESS:

CITY: STATE: ZIP CODE:

CREDIT/TRADE REFERENCES

COMPANY

PHONE NUMBER

FAX NUMBER

COMPANY INFORMATION

GROSS RENUES 2007

GROSS REVENUES 2006

GROSS REVENUES 2005

AVERAGE PROJECT SIZE? LESS THAN 50K 50K-100K 100K-250K 250K-500K 500K-1 MILLION

1 MILLION – 2 MILLION 2 MILLION +
MOST COMPETITIVE BIDDING WHICH SIZE PROJECT?
WHICH TYPE OF PROJECT DO YOU HAVE EXPERIENCE WORKING ON? Residential Commercial Industrial Government

RECENT PROJECTS

LIST YOUR LAST 3 COMPLETED PROJECTS ALONG WITH JOB VALUE AND SITE LOCATION

JOB NAME:

GENERAL CONTRACTOR:

PHONE #:

JOB VALUE:

SITE ADDRESS:

JOB NAME:

GENERAL CONTRACTOR:

PHONE #:

JOB VALUE:

SITE ADDRESS:

JOB NAME:

GENERAL CONTRACTOR:

PHONE #:

JOB VALUE:

SITE ADDRESS:

Signature Date

Name Title

Signature Date

Name Title

By signing above the undersigned guarantees that all information contained herein is true and accurate.  Any incorrect or misleading information is grounds for termination and or rejection by Rossi Construction of the undersigned.