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AIG

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Vendor/Consultant Certification Program Application Please understand that all information requested in this application will be kept CONFIDENTIAL. AIG respects your privacy, and does not intend to compromise your trust and goodwill. DEFINITIONS USED IN THIS APPLICATION Vendor/ business Entity: This is your Company. It may be an incorporated company, or an individual doing business as ( ) a company ( , John Smith, Smith Plumbing of Peoria). Applicant: The person signing this application (an owner, officer, principal partner, etc) who is authorized to engage in this application process. Principal: Any individual holding 5% or greater interest in the Vendor/ business Entity, and who would typically hold a title of owner, general partner, limited partner, officer, or director. Employee/Consultant Subcontractor: Employees, Consultants and Subcontractors are those individuals who do not own significant (5% or more) interest in the business Entity, and represent the Vendor/ business Entity at AIG.

INFORMATION ON VENDOR/BUSINESS ENTITY Vendor/Business Entity Name Fictitious Business Name (d.b.a.) Date Company Formed Current Address City County

  Business, Name, Business name

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