RCC Purchasing Department

Vendor Registration Request

Company Name
Mailing Address
City
State
Zip
Phone Number
Company Email
Web Page Address


Type of Business or Commodity



Is this business certified as one of the following? If so, indicate the certification number on the adjoining box. (Search OMWESB).

MBE (Minority owned Business Enterprise)
WBE (Women owned Business Enterprise)
ESB (Emerging Small Business)
QRF (Qualified Rehabilitation Facilities)
DBE (Disadvantaged Business Enterprise)
Other

Certification Number
Federal Tax I.D.


Comments



Submitted by	*
Email address	*




* Required Form Fields Rogue Community College supports affirmative action so that discrimination does not occur on the basis of race, color, sex, religion, national origin, physical or mental disability, or veteran's status.

Kimberly Haney - Procurement Specialist
Mary S. Gehret - Purchasing and Contracts Coordinator
Rogue Community College
541-956-7164
541-956-7236 Fax