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PTC Form # 79-07
PENNSYLVANIA TURNPIKE COMMISSION
Bidder’s Mailing List Application

ORGANIZATIONAL DATA
Company Name: PTC Vendor # (What's This?):
Company Name 2:    
ADDRESS TO WHICH BIDS AND PURCHASE ORDERS ARE TO BE MAILED
Street Address
Street Address
City    State      Zip  
County
Phone    Fax   
Primary Company Email Address
(Please provide a general email address such as "sales@company.com" if possible)
REMIT TO ADDRESS (IF DIFFERENT THAN ABOVE)
Corporate Name (if different)
Street Address
Street Address
City State Zip
County
TAX NUMBERS
Federal Taxpayer # (What's This?)
 SSN (Numbers Only. No Dashes) (If individual/Sole Proprietor)
 Employer ID Number (Numbers Only. No Dashes) (If Corporation or Partnership)
PA State Tax License # (Numbers Only. No Dashes)
CONTACT PERSONS
 
Full Name Function
Phone Fax
Mobile Email
 
Full Name Function
Phone Fax
Mobile Email
 
Full Name Function
Phone Fax
Mobile Email
 
YOUR BUSINESS STATUS
Application Status (Check all that apply) Certification/Verification Date**
(MM/DD/YYYY)
Not Applicable
** Please forward evidence attesting to certification/verification to:
Pennsylvania Turnpike Commission
Strategic Sourcing & Asset Management Department
P. O. Box 67676
Harrisburg, PA 17106-7676
Certification/Verification Sources:
  • Minority Business Enterprise (MBE) and Woman Business Enterprise (WBE) status must be certified by the Pennsylvania Unified Certification Program (PA UCP) as a Disadvantaged Business Enterprise (DBE).
  • A Small Business Enterprise (SBE) must be certified with the PA Department of General Services or with the U.S. Small Business Administration 8a Program.
  • A Veteran Business Enterprise (VBE) must be verified by the U.S. Department of Veteran Affairs.
  • A Service Disabled Veteran-Owned Business Enterprise (SDVBE) must be a veteran business enterprise (VBE) as defined above, and be in possession of a disability rating letter issued by the United States Department of Veteran Affairs or a disability determination from the United States Department of Defense.
  • A Regular Vendor is a business enterprise that does not qualify for any of the above business statuses.