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Purchasing Department
1600 Hampton Street
Columbia, SC 29208
Phone: (803) 777-4115
Fax: (803) 777-2032



 
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| ADMINISTRATION & FINANCE | BUSINESS AFFAIRS | PURCHASING | CONSOLIDATED SERVICES

Small and Minority Businesses Enterprise Registration

Business Name: *
Business Address: * Address 1
Address 2
City
State
Zip Code
Contact Name (1): *
Email: *
Telephone: *
Contact Name (2):
Email:
Telephone:
Contact Name (3):
Email:
Telephone:
Fax:
Small/Minority Business classification: *
Indicate the number of employees your firm has.
Indicate the number of years your firm has been in business under the present name.
Please list products that your company provides. *
Provide 3 business references for which you have provided these products.
Include company name and address, contact name, contact telephone number and e-mail address.
Product Reference 1: * Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Product Reference 2: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Product Reference 3: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Please list services that your company provides. *
Provide 3 business references for which you have provided these services.
Include company name and address, contact name, contact telephone number and e-mail address.
Service Reference 1: * Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Service Reference 2: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Service Reference 3: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Provide any government agencies (Federal, State or Local) references for which you have provided products or services.
Include agency name and address, contact name, contact telephone number and e-mail address.
Government Reference 1: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Government Reference 2: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Government Reference 3: Company Name
Address 1
Address 2
City
State
Zip Code
Contact Name
Telephone Number
Email
Check the box, if certified with any of the following entities.
Governor's Office of Small and Minority Business Assistance
Small Business Administration
Carolina's Minority Supplier Development Council
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