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eProcurement Vendor Addition Request Form
Instructions: Once completed and submitted this form will be sent to the Procurement department. It will be evaluated by either the Medical or Central Procurement departments depending on the specific commodities involved. You will receive a response to your request within 5 business days. Approval of your request is affected by the completeness and quality of the information provided.

 Requester Information   (all fields are required)
 Date Submitted   
 Name   
 Title   
 Department Name   
 VU Phone No.   
 Email Address   

 Vendor Profile   (all fields are required)
 Current Vendor to Vanderbilt?   
 Current Vendor to your department?   
 Estimated number of orders per month?   
 Estimated annual $ volume   

 Vendor Information
 Name (required)   
 Ordering Address   
       Address   
       City   
       State   
       Zip code   
 Web Address (url)   
 Telephone   
 Fax   
 Contact Name   
 Email Address   
 Products/Services   
 Are they a Diversity vendor?   

 Other Information   (if known)
 Are there other vendors in eProcurement that offer these products or services?   
 If yes, have you tried these existing vendors? If yes, what was your experience?   
 Does this vendor meet any unique requirements?