UC Davis Small and Diverse Business Registration

Your Contact Information

Your Name

Your Email

Your Phone Number

Are you a UC employee completing on behalf of the vendor?

Yes

Please provide us your contact information so that we can reach out if we have any questions

Different form This form is intented for supplier to complete. You can initiate a request on behalf of a supplier here: https://supplychain.ucdavis.edu/form/vendor-request-form

Supplier Information

Is your company an individual (including sole proprietor or single member LLC) or corporation?

Individual

Corporation

Are you, your company or the owners a current employee, been employed by the university in the last 2 years, or have direct relationship to an employee (spouse, child, etc.)?

Yes

Additional Form Required Please complete a Conflict of Interest form and attach below

Please attach the completed conflict of interest form

One file only.
256 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

What is your company's legal name?

Please provide the "Doing Business As" Name (this will be the name on the payments)

Please select the categories of goods or services your company provides

Commercial Services

Other…

Please provide the SIC codes that you provide

Please provide the SIC codes that you provide
Please provide the SIC codes that you provide
Please provide the SIC codes that you provide
Please provide the SIC codes that you provide

Please provide a brief description of the goods or services you provide. (150 characters max)

Please provide the link to your company's website (if available)

What is the Company's Physical Address

Address Line 1

Address Line 2

Address Line 3

Country

City

State / Province

Postal Code

Indicate if you have an additional address for Remittance

What is the Remittance Address

Address Line 1

Address Line 2

Address Line 3

Country

City

State / Province

Postal Code

Indicate if you have an additional address for Remittance

What is the Additional Address

Address Line 1

Address Line 2

Address Line 3

Country

City

State / Province

Postal Code

Select your preferred payment method

Please provide your Tax Number (if available)

Are you the primary contact for the company?

Yes

Please provide the name of the primary contact

Please provide the email for the contact

Please provide the phone # for the contact

Payee First Name

Payee Last Name

Does your company have a California address?

Yes

Does your company Collect California sales tax?

Yes

Insurance Information (if available)

Please select an insurance type

Please provide the insurance policy number

Insurance Coverage Amount

Expiration Date

UC Regents Additional Insured?

Active?

Attach a copy of your insurance

Please check if you have additional insurance information that you want to add

Additional Insurance Information

Please select an insurance type

Please provide the insurance policy number

Insurance Coverage Amount

Expiration Date

UC Regents Additional Insured?

Active?

Attach a copy of your insurance

Please check if you have additional insurance information that you want to add

Additional Insurance Information

Please select an insurance type

Please provide the insurance policy number

Insurance Coverage Amount

Expiration Date

UC Regents Additional Insured?

Active?

Attach a copy of your insurance

Are you already affiliated with the university?

Active Student (undergraduate or graduate)

UC Employee (staff)

UC Employee (faculty)

UC Non-employee Affiliate

Not affiliated with the university

Attach W9

If you currently have the supplier's W9, please attach it here. If not, we will contact you with the supplier number to attach through our supplier portal.