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Prospective Supplier Questionnaire
*
1.
Vendor name:
(Required.)
2.
Vender diversity designation (if any):
*
3.
Rep contact name:
(Required.)
*
4.
Rep contact email:
(Required.)
*
5.
Rep contact phone number:
(Required.)
*
6.
Type of offering:
(Required.)
Product
Service
Technology
*
7.
Category of supply, service, or department that would use the supply or service:
(Required.)
Nursing
PeriOp
Cath Lab
Radiology
Lab
IT
Food
EVS
Facilities
Corporate Services
*
8.
Description of supply or service available:
(Required.)
*
9.
What is the typical ROI for an organization with your product or service?
(Required.)
*
10.
Are you a part of any GPO contract?
(Required.)
Yes
No
