Vendor Certification Form

*
Company Contact Information
*
City:
*
State/Province:
*
Zip Code:
*
Country:
Web site address:
*
Name of person completing form:
*
Are you currently a MedAssets Contracted Vendor?
Please enter your Dun & Bradstreet D-U-N-s Number.
*
From the listing of MedAssets Programs select the ONE area that best describes where your company is focused.
If Construction, please list your CSI code.
*
Please select a category that best fits the product line you would like MedAssets to consider your application for. (A new application is required for each product category)
*
Name of Chief Executive Officer or Company Owner:
Powered by SurveyMonkey
Check out our sample surveys and create your own now!