State of Kansas Bidders Survey

1. State of Kansas Bidders Survey

Please complete this application with contact data and information for you and your company. NOTE: You only need to submit this application once, but you will need to keep the company information and email addressed current to receive bid solicitations.

Upon completion of this application, you MUST immediately fax a copy of your current Federal W-9 Form (Request for Taxpayer Identification Number and Certification) to the Division of Purchases (DoP) at 785-296-7240. You may also email the W-9 Form to: bids@da.ks.gov . Your application will not be processed without the W-9 form. A copy of the blank W-9 form is available at the DoP website http://www.da.ks.gov/purch/forms.htm

If you need assistance with filling out the Bidder Application Survey, please call 785-296-2373.

Questions marked with an asterisk (*) are required and must be answered to complete the application.

*
1. Choose One:

Choose One: New Application (Never submitted an application before)

Information Update: (Application on file needs: changes to address, email, phone or contact person, additional categories selections).

*
2. What is your official Company Name? (Should match the W-9 Form)

What is your official Company Name? (Should match the W-9 Form)

3. What is the URL for your Company's website?

What is the URL for your Company's website?

*
4. Company Contact Person:

Company Contact Person: First Name
Last Name

5. Contact Person Title:

Contact Person Title:

*
6. Contact Person Email (This MUST be a current email address that can receive Bidding Notices and Purchase Orders. If the email address changes you must notify the Division immediately.):

Contact Person Email (This MUST be a current email address that can receive Bidding Notices and Purchase Orders. If the email address changes you must notify the Division immediately.):

*
7. Phone Number (Please include Area Code):

Phone Number (Please include Area Code):

8. Telephone Extension:

Telephone Extension:

*
9. Fax Number (Please include Area Code):

Fax Number (Please include Area Code):

*
10. What is your Company's Mailing Address?
(This must be a current address which will receive bid solicitations or correspondence. It will be your responsibility to send timely notification of any change.)

What is your Company's Mailing Address? (This must be a current address which will receive bid solicitations or correspondence. It will be your responsibility to send timely notification of any change.)

11. If your mailing address has additional lines, please enter them here (i.e., Suite Numbers, Postal Drops, etc.).

If your mailing address has additional lines, please enter them here (i.e., Suite Numbers, Postal Drops, etc.). Address Line 2:
Address Line 3:
Address Line 4:

*
12. City:

City:

13. County:

County:

*
14. State: (2 Characters)

State: (2 Characters)

*
15. Postal/Zip Code (When using +4):

Postal/Zip Code (When using +4):

*
16. Please enter your 9-digit Tax Identification Number

Please enter your 9-digit Tax Identification Number

Upon completion of this application, you MUST immediately Fax a copy of your current Federal W-9 Form (Request for Taxpayer Identification Number and Certification) to the Division of Purchases (DoP) at 785-296-7240. You may also email the W-9 Form to: bids@da.ks.gov . Your application will not be processed without the W-9 form. A copy of the blank W-9 form is available at the DoP website http://www.da.ks.gov/purch/forms.htm

State of Kansas Bidders Survey

1. State of Kansas Bidders Survey

*1. Choose One:

*2. What is your official Company Name? (Should match the W-9 Form)

3. What is the URL for your Company's website?

*4. Company Contact Person:

5. Contact Person Title:

*6. Contact Person Email (This MUST be a current email address that can receive Bidding Notices and Purchase Orders. If the email address changes you must notify the Division immediately.):

*7. Phone Number (Please include Area Code):