Supplier Application

Suppliers are required to apply all sales taxes applicable to the state of Indiana. This application does not constitute an agreement to do business.
Company Info
Company Name*
Corporate Address*
Street Address Address Line 2 City State ZIP Code
Main Contact Name*
First Last
Main Contact Phone*
Main Contact Email*
Do you want to be setup with a user name and password in order to participate in bid events?*
- Yes
- No
Does your company have an address different than the corporate address that needs to be shown on purchase orders or contracts?
- Yes
- No
Sales Contact Name*
First Last
Sales Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Sales Phone*
Sales Contact Email*
Does your company have an address different than the corporate address for payment remittance?
- Yes
- No
A/R Contact Name*
First Last
A/R Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
A/R Phone*
A/R Contact Email*
Is your company located in a "Hubzone"?
- No
- Yes
Is your Company a Certified Woman, Minority, Veteran Small Business or Disadvantaged Business? If Yes to any, please attach a copy of your certificate.*
Check all that apply.
- No
- IDOA WBE
- IDOA MBE
- IDOA IVOSB
- INDOT DBE
- Other State DBE
- National DBE
Certificate Upload*
Please upload a copy of all certificated indicated in the previous question.
Drop files here or

Accepted file types: jpg, jpeg, pdf, gif, png.
Do you offer Net45 payment terms?*
- Yes
- No
If no, what terms do you offer?*
Do you offer early-pay discounts?*
- Yes
- No
Does your company accept payment by Mastercard credit card?*
- No
- Yes
- Yes, but there is a fee
Additional Documents*
Please upload your completed W9 or W8 and any other pertinent documents (W/MBE certification, line card, ACH payment instructions, location listing).
Drop files here or

Accepted file types: jpg, jpeg, pdf, gif, png.
Which best describes your supply/service area regarding the Toll Road?*
- Local to my city only
- From IL border to Elkhart
- From Elkhart to OH border
- All of road
Choose all services/product categories that apply to your company*
- Accounting and auditing
- Additives
- Adhesives and sealants
- Advertising
- Aggregates
- Air cargo transport
- Asphalts
- Asset recovery service
- Batteries and cells and accessories
- Bolted structural assemblies
- Bridge construction and repair service
- Bridge Painting Service
- Bridge rail
- Building Maintenance and Repair Service
- Building site preparation services
- Business and corporate management consultation services
- Business facilities oversight
- Carpentry
- Civil engineering
- Cleaning and janitorial services
- Cleaning and janitorial supplies
- Clothing
- Coating and caulking and weather and water and fireproofing
- Commercial and office building renovation and repair service
- Commercial or industrial construction
- Community and social services
- Computer Equipment and Accessories
- Computer Hardware maintenance and support
- Computer hardware rental or leasing services
- Computer services
- Concrete and cement and plaster
- Concrete reinforcement hardware
- Concrete work
- Construction and Maintenance support equipment
- Construction machinery and equipment rental or leasing services
- Corporate finance
- Data services
- Decontamination services
- Demolition services
- Dirt and soil
- Disaster preparedness and relief
- Disaster recovery services
- Document scanning service
- Drilling and exploration equipment
- Education and Training Services
- Electrical equipment and components and supplies
- Electrical services
- Electrical wire and cable and harness
- Energy conservation
- Environmental control systems
- Environmental Services
- Exterior finishing materials
- Exterior lighting and fixtures
- Fabricated structural assemblies
- Facilities management
- Facility maintenance and repair services
- Fencing
- Finishing materials and products
- Fuel tanks and systems
- Fuels and Fuel Additives and Lubricants and Anti corrosive Materials
- Furniture and Furnishings
- General building construction
- Grinding and polishing and smoothing materials
- Hand tools
- Hardware
- Hazardous waste disposal
- Health programs
- Healthcare centers
- Healthcare Services
- Heating and ventilation and air circulation
- Heating system maintenance and repair service
- Heavy construction machinery and equipment
- Heavy construction services
- Herbicides
- Highway and road construction services
- Highway and road maintenance service
- Highway and road paving service
- Highway and road sign or guardrail construction and repair service
- Highway engineering
- Highway reflector installation service
- Human resource development
- Human resources services
- Hydraulic machinery and equipment
- Industrial buildings and structures
- Industrial management
- Industrial use gases
- Information retrieval systems
- Information services
- Information technology service
- Inspection
- Insulation
- Insurance and retirement services
- Insurance services for structures and property and possessions
- Interior finishing
- Interior finishing materials
- Interior lighting and fixtures
- International trade
- Internet services
- Janitorial equipment
- Laboratory and Measuring and Observing and Testing Equipment
- Lamps and lightbulbs and lamp components
- Land and soil management
- Land and soil preparation
- Laundering services
- Lease and rental of property or building
- Legal compliance certification service
- Legal services
- Life and health and accident insurance
- Lighting and fixtures and accessories
- Mailing services
- Mailing supplies
- Management advisory services
- Management information systems MIS
- Marine cargo transport
- Market research
- Marketing and distribution
- Material packing and handling
- Mechanical engineering
- Mining services
- Mobile communications services
- Motor vehicles
- News and publicity services
- Nonhazardous waste disposal
- Office Equipment and Accessories and Supplies
- Office equipment rental or leasing services
- Office supplies
- Oil spill cleanup
- On line data processing
- Packaging materials
- Painted or coated exterior flooring services
- Paints and primers and finishes
- Pallets
- Panel and paint services
- Paper products
- Parking facility construction and equipment installation and maintenance and repair services
- Passenger road transportation
- Permanent structures
- Permitting services
- Personal safety and protection
- Personnel recruitment
- Pest control
- Photographic services
- Pipe piping and pipe fittings
- Plants and ornamental trees
- Plumbing construction services
- Postal and small parcel and courier services
- Power generators
- Printing
- Professional engineering services
- Project management
- Public administration and finance services
- Public relations and professional communications services
- Pump parts and accessories
- Pumps
- Quality control
- Recycling services
- Refuse collection and disposal
- Restaurants and catering
- Road and railroad construction materials
- Road cargo transport
- Roads and landscape
- Roadway or highway lighting
- Roofing materials
- Safety apparel
- Safety footwear
- Sales and business promotion activities
- Sampling services
- Scrap and waste materials
- Security surveillance and detection
- Siding and exterior wall materials
- Software
- Software maintenance and support
- Software or hardware engineering
- Storage
- Structural building products
- Structural exterior cleaning services
- Structural materials and basic shapes
- Supply chain management
- Tanks and cylinders and their accessories
- Telecommunications media services
- Temporary personnel services
- Tires and tire tubes
- Toxic and hazardous waste cleanup
- Trade shows and exhibits
- Traffic control
- Transportation engineering
- Transportation related equipment and instruments
- Transportation repair or maintenance services
- Transportation services equipment
- Travel agents
- Uniforms
- Utilities
- Vehicle Maintenance and Repair Services
- Warehousing equipment and supplies
- Water resources development and oversight
- Well testing services
- Wood
Name
This field is for validation purposes and should be left unchanged.

Company Info