Vendor File Application

* Person Filling out Form * Title * Name of Applicant * Email * Commodity/ Service Code No(s) Commodity or Service Code Numbers Agency
Corporation
Federal Agency
Local Govt
State Govt
Other
Proprietorship
Partnership * For Proprietorship or Self Employed, Enter owner's full name including middle initial * Enter Owner's Personal Social Security Number (If different from Tax ID above) * Contact Person * Title * Mailing Address * City * State * Zip * Phone Ext. Fax Email Remittance Address * Contact Person * Title * Address * City * State * Zip * Phone Ext. Fax Email Persons Authorized to Sign Bids, Offers and Contracts * 1. 2. 3. 4. Names of Officers, Members of Partnership, Owners, etc. * Name Name Name Name Type of Organization * Title Title Title Title * Type of Business * Tax ID Number Mailing Address (for Bids, purchase orders etc) (eg. Private Non-Profit Group) Indicate: / Self Employed (Must also provide Owner's name and Personal SSN- see below) (School, Water District etc.) . (Cities, Counties) . (Any State) Incorporated in the state of


Home > Departments > Administrative Services > Procurement Services > Vendor Application	Wednesday, May 16, 2012