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Vendor Registration Form
Vendor Registration Form
Vendor Registration Form
Vendor Registration Form
Thank you for your interest in working with GRTC!
Contact Information
Company Name
(Required)
DBA
Company Contact
(Required)
Phone
(Required)
Fax
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
(Required)
Company Information
Business Certifications
SWAM: MBE
SWAM: WBE
SWAM: SBE
DBE
None
Diversity Classification
(Required)
Minority Business Enterprise (MBE)
Women Business Enterprise (WBE)
Small Business Enterprise (SBE)
Minority Owned, Small Business Certification (MS)
Women Owned, Small Business Certification (WS)
Disadvantaged Business Enterprise (DBE)
None
Number of Employees
Number of Employees
Annual Gross Receipts
Less than $100,000
$100,000 to $250,000
$250,000 to $500,000
$500,000 to $1 million
$1 million to $2 million
$2 million to $5 million
$5 million to $10 million
$10 million or greater
Year of Annual Gross Receipts
(Required)
EIN Number
(Required)
Type of Business
(Required)
Legal Structure Corporation
LLC
Joint Venture
Limited Liability
Limited Liability Corporation
Partnership
Sole Proprietership
Company Products and Services
NAICS Codes
NGIP Codes
Company is Registered with
eVA
Virginia Dept of Small Business & Supplier Diversity
Small Business Administration
None
Business Certifications
Minority Business Enterprise (MBE)
Certification Number
Expiration Date
Women Business Enterprise (WBE)
Certification Number
Expiration Date
Small Business Enterprise (SBE)
Certification Number
Expiration Date
Minority Owned with Small Business Certification (MS)
Certification Number
Expiration Date
Women Owned with Small Business Certification (WS)
Certification Number
Expiration Date
Disadvantaged Business Enterprise (DBE)
Certification Number
Expiration Date
