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Supplier Registration/Information Form

Please provide the following required information to be included on the Lake Michigan College bidder list.

Mailing Address

Mailing Address

Remittance Address

(if different from mailing address)

Remittance Address

LMC is committed to increasing special interest group vendor participation. Please help us meet our commitments by checking appropriate information below if applicable:

Minority groups include:
  • Black/African American
  • Hispanic (Mexican, Puerto Rican, Cuban, Central or South American, other Spanish origin, regardless of race)
  • Asian (including Pacific Islander)
  • American Indian (including Alaskan native)
  • Handicapped
  • Disabled American Veteran
  • Vietnam Era Veteran
Type of Business
Retail Trade
Wholesale Trade
Construction Services
Service Industry
Manufacturing
Individual
Partnership
Corporation
Small Business (fewer than 250 employees and yearly sales grossing not more than $500,000)

Bank Reference

Information about your services

Maximum 5 files.
128 MB limit.
Allowed types: gif jpg png pdf doc docx ppt pptx zip.
A blank form is available on the IRS website.
One file only.
128 MB limit.
Allowed types: gif jpg png pdf doc docx.

Certification

The undersigned certifies that the information contained herein is correct. I understand that misrepresentation may be cause for removal from the Bidders Mailing List and any other penalties allowed by law. Further, I affirm that this company does not discriminate in employment practices because of race, color, creed, sex, age, height, weight, handicap or religious practice.

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