Company/Contact Information Company Name: D.B.A. Name: Business Type/Category: --None-- Advertising/Marketing/Graphic Design Audio/Visual/Production Catering/Food & Beverage Event Support (i.e. Event Planner, Entertainment, Venue, Art/Artist, Culture/Tours, Transportation) Gifts/Promotional items Media (i.e. Content Creator, Social Media, Blogger) Office Supplies Photography Professional Services Other* If Other* category, please enter here: Tax ID#: Contact First Name: Contact Last Name: Contact Email: Contact Phone #: Street Address: Address 2: City: State: --None-- ** - ** AB - Alberta AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona BC - British Columbia CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MB - Manitoba MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NB - New Brunswick NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NL - Newfoundland and Labrador NM - New Mexico NS - Nova Scotia NSW - New South Wales NT - Northwest Territory NU - Nunavut NV - Nevada NY - New York OH - Ohio OK - Oklahoma ON - Ontario OR - Oregon PA - Pennsylvania PE - Prince Edward Island QC - Quebec Qld - Queensland RI - Rhode Island SA - South Australia SAN - Santiago SC - South Carolina SD - South Dakota SK - Saskatchewan Tas - Tasmania TN - Tennessee TX - Texas UT - Utah VA - Virginia Vic - Victoria VT - Vermont WA - Washington WA - Western Australia WI - Wisconsin WV - West Virginia WY - Wyoming YT - Yukon Zip: Country: UNITED STATES CANADA MEXICO AFGHANISTAN ÅLAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA, PLURINATIONAL STATE OF BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANARY ISLANDS CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CURACAO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KOSRAE KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PONAPE PORTUGAL PUERTO RICO QATAR RÉUNION ROMANIA RUSSIAN FEDERATION RWANDA SABA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAIPAN SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SCOTLAND SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA ST. BARTHELEMY ST. CHRISTOPHER ST. CROIX ST. EUSTATIUS ST. JOHN ST. MAARTEN ST. MARTIN ST. THOMAS SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TINIAN TOGO TOKELAU TONGA TORTOLA TRINIDAD AND TOBAGO TRUK TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNION ISLAND UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA, BOLIVARIAN REPUBLIC OF VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALES WALLIS AND FUTUNA WESTERN SAHARA YAP YEMEN ZAIRE ZAMBIA ZIMBABWE Payment Address (if different from mailing address): Address 2: City: State: --None-- ** - ** AB - Alberta AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona BC - British Columbia CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MB - Manitoba MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NB - New Brunswick NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NL - Newfoundland and Labrador NM - New Mexico NS - Nova Scotia NSW - New South Wales NT - Northwest Territory NU - Nunavut NV - Nevada NY - New York OH - Ohio OK - Oklahoma ON - Ontario OR - Oregon PA - Pennsylvania PE - Prince Edward Island QC - Quebec Qld - Queensland RI - Rhode Island SA - South Australia SAN - Santiago SC - South Carolina SD - South Dakota SK - Saskatchewan Tas - Tasmania TN - Tennessee TX - Texas UT - Utah VA - Virginia Vic - Victoria VT - Vermont WA - Washington WA - Western Australia WI - Wisconsin WV - West Virginia WY - Wyoming YT - Yukon Zip: Country: UNITED STATES CANADA MEXICO AFGHANISTAN ÅLAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA, PLURINATIONAL STATE OF BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANARY ISLANDS CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CURACAO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KOSRAE KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PONAPE PORTUGAL PUERTO RICO QATAR RÉUNION ROMANIA RUSSIAN FEDERATION RWANDA SABA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAIPAN SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SCOTLAND SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA ST. BARTHELEMY ST. CHRISTOPHER ST. CROIX ST. EUSTATIUS ST. JOHN ST. MAARTEN ST. MARTIN ST. THOMAS SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TINIAN TOGO TOKELAU TONGA TORTOLA TRINIDAD AND TOBAGO TRUK TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNION ISLAND UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA, BOLIVARIAN REPUBLIC OF VIET NAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALES WALLIS AND FUTUNA WESTERN SAHARA YAP YEMEN ZAIRE ZAMBIA ZIMBABWE W-9 Form: Please upload your completed W-9 form ACH Information: Please upload your ACH Information Minority Business Enterprises (MBE) Owned: udf_3829 Yes No Women Business Enterprises (WBE) Owned: udf_3827 Yes No Business Enterprises owned by People with Disabilities (BEPD): udf_3820 Yes No Veteran Business Enterprises (VBE) Owned: udf_3821 Yes No Lesbian/Gay/Bisexual/Transgender Business Enterprises (LGBTBE) Owned: udf_3822 Yes No
Certification(s) Firms must be certified by one of the five entities from which we accept certifications. Currently we accept certifications from the City of Chicago, Cook County Government, the State of Illinois Department of Central Management Services, Chicago Minority Supplier Development Council, and the Women’s Business Development Council. If you are not currently certified, but are interested, you will find links below pointing to certifying agencies that we accept:
City of Chicago, Department of Procurement Services Chicago Minority Supplier Development Council (CMSDC)County of Cook Women’s Business Development Center (WBDC)State of Illinois, Central Management Services
Minority Business Enterprises (MBE) Certified: udf_3819 Yes No Certificate for MBE: Please upload your MBE Certification MBE Certificate Expiration Date: Women’s Business Enterprises (WBE) Certified: udf_3818 Yes No Certificate for WBE: Please upload your WBE Certification WBE Certificate Expiration Date: Other Certification: Please upload other Certification (BEPD, VBE, LGBTBE) if applicable Certificate Expiration Date: Other Certification: Please upload other Certification (BEPD, VBE, LGBTBE) if applicable Certificate Expiration Date:
Red fields are required. Submit Reset