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2. VILLAGE OF SKOKIE VENDOR APPLICATION FORM
4. VILLAGE OF SKOKIE PURCHASING DIVISION
6. 5127 Oakton Street
8. Skokie, Illinois 60077
10. (847)933-8240 Fax: (847)568-8840
12. INSTRUCTIONS: In order to be placed on the Village of Skokie Vendor List, please respond to all required questions, and sign in the space provided. If the appropriate answer is "same", "not applicable", or "none", please write this to indicate no questions have been overlooked.
14. 1. CONTACT INFORMATION
    Name of business, street address (no P.O. Box), City, State and Zip Code:
16. Address*
18. City*
19. State*
20. Zip Code*
22. Contact Person:*
23. Title:*
24. Web Site URL:*
26. Phone Number*
27. Fax Number
29. Email Address*
31. 2. BUSINESS ORGANIZATION:
    Please check the appropriate form of business organization below.
33. Organization*

    Corporation Sole Proprietor Individual Partnership

    1. Michael.Aleksic@skokie.org, Marie.Dahm@skokie.org
35. Please list names of corporate officers and Directors (for Corporation)
37. Corporate Officers*
38. Corporate Directors*
40. Please provide Taxpayer Identification Number (FEIN): (Use Social Security Number if a Sole Proprietor).
42. Number:*
44. 3. FINANCIAL INFORMATION:
46. Date Business established:*
48. Bank Reference:
50. Bank Name*
51. Telephone*
52. Contact Person*
54. 4. REFERENCES: Please provide the name of at least three (3) references for your firm (use additional sheets if necessary).
56. Name*
57. Organization*
58. Telephone Number*
60. 5. PRODUCT AND SERVICE CLASSIFICATIONS: Please provide a list of products and service you would like to provide to the Village. Please use additional sheets if required:*
62. The undersigned certifies to the following: 1. The undersigned is authorized to sign this form on behalf of the applicant. 2. All information shown on this form is correct.
64. Signature*
65. Printed Name*
66. Date*
68. Title*
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field