Vendor Application

All Staffing Agencies: please refer to apsstaffing.org

Required fields in bold
Please Select One:	Contract	Business Affiliate
Company:
Contact Name:		Title:
Address:
City:		State:
Zip:
Phone:		Fax:
Contact Email:
Company Website:
Years in Business:

What is (are) your core service(s)/product(s)? Please list:

What is your distribution or market area?

How do you think APS can help you achieve increased sales?

What are the key benefits to our Participants?

Does your company provide service and products directly, through a distributor network, or both? Which distribution venue is preferred?

State the current status of the market regarding competition, market share, product development, and new development trends?

Does your company have approval from all federal, state, and local regulatory agencies?

Please list any quality control or process improvement programs currently employed by your company in its manufacturing, distribution, and/or customer service operations.

What is the standard protocol for processing/handling customer complaints?

Please list 3 client references (Preferably from healthcare facilities in Kansas & Missouri) Please Include Organization name, contact name, email address and phone number

How did you hear about APS?
Are you a disadvantaged Enterprise?	Yes:	No:
If so, what classification?	WBE (Women Owned):	MBE (Minority Owned):
Other Comments for consideration: