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Supplier Qualification Form

Have you worked with anyone at Qwest regarding this program?

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Qwest Contact

Company Info

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Company Name *

Business Type *

Federal Tax ID *

DUNS number *

NAICS Codes *
reference list


Enter between 2 and 6 digits.

Business Category * (Check all that apply)

U.S. Small Business Administration – Glossary

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Large Business Small Business Small Disadvantaged Business Veteran Owned Business Service Disabled Veteran Owned Business Historically Black College/University Woman Owned Business HUB Zone

Street Address

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Address 1 *
Address 2
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State/Province *
Zip/Postal Code *

Mailing Address

Same as Street Address

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Address 1 *
Address 2
City *
State/Province *
Zip/Postal Code *

Supplier Contact Info

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First Name *
Last Name *
Phone *
Fax *
E-mail *
Title *

Required Attachments

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Capability Statement	(PDF, Word, or Powerpoint)
ORCA Record	(PDF, Word, or Powerpoint)

Additional Attachments (optional)

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Add Attachment (GSA Schedule Information, Certifications, etc)	(PDF, Word, or Powerpoint)

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