Procurement

Register as a Vendor

Please provide us with the following information so we may complete your supplier profile. When we receive your profile we will notify you by e-mail.

* denotes required field

Please indicate the profile type:
New Profile Updated Profile

Owner Information

Company Name: *

Salutation:

First Name: *	Middle Name:	Last Name: *

Owner's Title: *

Contact Information

Same as Owner Information:

Salutation:

First Name: *	Middle Name:	Last Name: *

Title: *

Contact's Email: *

Web Site:

Physical Address: *

Suite:

City: *	State: *	ZipCode: *
	(Ex. TX)	-

County: *
(Ex. Harris County)

Mailing Address

Same as Physical Address

Mailing Address:

Suite:

City:	State:	ZipCode:
	(Ex. TX)	-

County:
(Ex. Harris County)
Telephone Number: *
( )- - ext.
Fax Number:
( )- -

Business Information

Type of Organization: *

Please fill in the category that best describes your business.

Main Commodity: *

Sub Commodity: *

Main Service: *

Sub Service: *

If you have entered both a commodity and a service, please specify your 'Primary' category.
Commodity Service

Please use the following link to find your appropriate NAICS code.

North American Industrial Code System (NAICS code): *

Based on your primary NAICS code and the Small Business Administration Standards (SBA) (www.sba.gov/size/indextableofsize.html), the company is:
(Contact SBA at 1-800-8ASK-SBA)

Certification: (e.g. Minority Business Enterprise, etc.)

Agency's Name:

Expiration Date:

Certification: (e.g. Minority Business Enterprise, etc.)

Agency's Name:

Expiration Date:

Certification: (e.g. Minority Business Enterprise, etc.)

Agency's Name:

Expiration Date:

Certification: (e.g. Minority Business Enterprise, etc.)

Agency's Name:

Expiration Date:



Terms and Agreement We must receive a copy of your certification within 30 days in order to complete your profile. Please forward your information to fax number 414.482.2151 or mail to Veolia Water Milwaukee, Attn: Barbara Brown, 700 E. Jones St., Milwaukee, WI 53207.
Information prepared by: *
Name:		Date: 5/21/2013
Title:
Under 15 U.S.C. 645(d), any person who misrepresents a firm's status as a small or small disadvantaged business concern in order to obtain a contract to be awarded under the preference programs established pursuant to section 8(a), 8(d), 9, or 15 of the Small Business Act or any other provision of Federal law that specifically references 8(d) for a definition of program eligibility, shall (i) Be punished by imposition of fine, imprisonment, or both; (ii) Be subject to administrative remedies, including suspension and debarment; and (iii) Be ineligible for participation in programs conducted under the authority of the Act.
Please check this if you have read and understand the 15 U.S.C. 645(d) clause. *

Procurement

Procurement

Register as a Vendor

Owner Information

Contact Information

Mailing Address

Business Information

Certification Information

Terms and Agreement

Sustainability

Community Partnerships