ShawDesign Test

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Vendor Information:
Vendor type	SubcontractorSupplier
Name
Address
Address
City
State	e.g. CA
Zip	xxxxx-xxxx
Tax Id
Business Classification	(Check appropriate boxes) Large Woman-Owned Non-Profit Foreign Small (Check All Subclassifications That Apply) Woman-Owned Veteran Owned Service Disabled Veteran HUBZone (Copy of SBA Certification Letter Required) Qualified Non-Profit Disadvantaged (Copy of SBA Certification Letter Required) Black American Hispanic American Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians) Alaska Native Corporation Indian Tribe Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia, (Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust Territory of the Pacific Islands (Republic of Palau), Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru) Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal) Individual/Concern, other than one of the preceding
Prior Experience With Shaw	YesNo
Services Provided

Vendor Contact Information:
Contact Name
Contact Title
Contact Phone	(xxx) xxx-xxxx