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OHSU Vendor Registration Form
Please use this form to submit your business information to OHSU for consideration as a supplier or vendor.
*
1
. Company Name
Company Name
*
2
. Contact Information
Contact Information
Name
Title
Address 1
Address 2
City
State
Zip
Email Address
Phone
*
3
. Check all the boxes that apply.
Check all the boxes that apply.
Woman Owned – State Certified
Minority Owned – State Certified
Emerging Small Business – State Certified
Disabled Veteran’s Enterprise – Self Reported
Disadvantaged Business Enterprise – State Certified
Not Applicable
4
. Product or Services Offered
Product or Services Offered
5
. Business Purpose
Business Purpose
6
. Comments
Comments
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