Vendor Information Reporting Form

Vendor Information Reporting Form

Pursuant to the Illinois General Assembly Revenue Property Tax Code (35 ILCS 200/18-50.2), Schaumburg Park District is required to make a good faith effort collect and electronically publish data from all vendors and subcontractors doing business with the District. Thank you for providing the information requested.
Company Information
Company Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Company Status
Please check all that apply:
If applicable, list any certifications your organization holds for the above categories.
Is the organization self-certifying? (Schaumburg Park District shall publish whether the vendor qualifies as a small business under federal Small Business Administration standards.)
By signing below, you represent and warrant that the information on this Vendor Information Reporting Form is accurate and complete to the best of your knowledge.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Company Information