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VENDOR INFORMATION QUESTIONNAIRE

* Fields are mandatory.

*Company Name:
*Address:
*City, State:
*Work Phone:
Fax:
Year Company Started:
Main Staffing Contact:
Prior Fiscal Year Annual Gross Sales:
Federal ID:
No. of Employees (W2):
No. of contract personnel currently assigned:



*Zip:
*Cell Phone:
Website URL:


*Email:

Dun & Bradstreet Number:

GENERAL BUSINESS INFORMATION

Description of products/services:

Describe your process and method to find qualified contract personnel:

List the top three positions for which you have expertise in filling for our clients:

List at least three current customers for whom you are providing staffing services. List company name, contact name and phone number and email (one or more customers may be called as a reference):

List the main States you are able to support:

Please identify how your business is classified by checking the appropriate box:

African American	Asian – Indian American	Asian – Pacific American
Hispanic American	Native American	Women Owned
Not Applicable

Please provide your minority certificate (if applicable).

Insurance:
Provide coverage amounts. If not applicable, please enter a zero, '0', for the amount.

Comprehensive/General Liability:

Umbrella Liability:

Professional Liability:

Workers Compensation:

Auto Liability:

Other:

Are you willing to add Staffing Tree as additional insured? Yes No

OTHER

How did you hear about Staffing Tree?

Other comments you would like to share that will help us understand your capabilities:

Signature below represents that all supplied information is complete and accurate.

Print name:

Date: (date format:YYYY-MM-DD)

Submission of this form is for informational purposes only. It does not guarantee any contracts will be awarded or ensure "Approved" Vendor status.

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