AUTHORIZED SERVICING DEALER & MAUNFACTURER



Authorized Dealer Form

AUTHORIZED DEALERS

Per Section 3.1 of the ITN, “Authorized Dealer” means an agent/reseller/dealer/subcontractor authorized by the Manufacturer, in writing, to provide products and/or services under the DIRECT SUPERVISION of the Manufacturer.

Please list below all authorized dealers that will be providing product or service by participating on your State Contract.* Please note that any dealer receiving orders on this contract must be registered in MyFloridaMarketPlace and with the Division of Corporations.

The following information must be completed in its entirety for each dealer:

Dealer Name: Integral Consulting Services, Inc. (Small Business – 8(a), WO)

Dealer Address:704 Quince Orchard Road, Suite 290

City, State, Zip Code: Gaithersburg, MD, 20878

Office Phone/Fax: 301-990-0880 / 301-294-4673



Email Address: ajohri@

Contact Person: Abhai John

Vendor Tax ID Number: 52-2081090

*Please identify any CMBE (Certified Minority Business Enterprise) dealers participating in this contract.

Certified 8(a),woman-owned SDB

CMMI Level 2 Certified

(This form may be duplicated as necessary.)

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