Vendor Registration

Company Name:

Type of Business:

Type of Equipment, Supplies, Materials sold or type of Services provided:

Names of Principal Owner(s), Officers, or Partners:

Names of designated people, if not Owners, Officers or Partners, authorized to make offers or sign bids and contracts:

Length of time in present business:

Number of times the Company has previously bid on supplying the municipality with goods or services:

Company Name:

Mailing Address:

City:

State:

Zipcode:

Telephone Number:

Fax Number:

Name of Contact Person:

Email Address:

Note: Your responses will assist us in evaluating your firm for future bid opportunities. Information on this form must be the same as listed on the Request for Taxpayer Identification Number and Certification (Form W-9), as required by the Internal Revenue Service. You will also need to submit a completed, signed W-9 form by fax, mail or in person. Also if you are a sole proprietor, you must furnish your individual name, you may also enter your business name or doing business as DBA (Doing Business As).

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