Transcription of Gaston County Schools - WPBOA
1 Revised 9/9/13 Order Address (Purchase Orders sent Remit To Address (Payment sent to:) Name Name Address Address City City State Zip County State Zip County Federal ID Number OR Social Security Number (if applicable) E-Mail: Contact Person Telephone Number ( ) Fax Number ( ) Gaston County Schools Purchasing Dept. 1351 Bradford Heights Rd., Gastonia, NC 28054 Phone: (704) 810-8802 Fax: (704) 866-6140 Email: VENDOR APPLICATION To qualify for a Minority Business Enterprise status, your business must be certified by the NC Office of Historically Underutilized Businesses, 51% of your business must be owned and controlled by a minority group, woman, or the disabled.)
2 For the purpose of this definition, Minority Business Enterprise members are African Americans, Asian Americans, Hispanic, Native Americans, Women and/or the Disabled. If you qualify, please mark the appropriate space following the description. African American Asian American Hispanic Native American Woman-Owned Enterprise Disabled Business Enterprise Non- Profit Work Center- Blind & Severely Disabled Socially & Economically Disadvantaged If you do not qualify for Minority Business Enterprise status, please mark N/A. N/A Please respond by marking the appropriate space: Yes No Yes No Are you collecting retirement from the NC Teachers and State Employees Retirement System?
3 (response is required) Are you an individual? Are you an LLC? Are you incorporated? Do you provide goods? Do you provide services? Signature of responding company official or payee Date FOR GCS OFFICE USE ONLY Vendor Number: Requested By.
