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Central Purchasing: New Vendor Application

2. New Vendor Application
4. Company Information:
6. Legal Company Name:*
7. DBA (if applicable)
8. Year In Business*
10. Federal Tax ID Number*
11. Duns & Bradstreet Number
12. Cage Code
14. Address*
16. City*
17. State*
18. Zip Code*
20. Contact Information
22. Sales & Service
24. Name*
25. Email Address*
27. Title*
28. Phone Number*
29. Fax Number
31. Authorized to Agent to Sign Bid and Quotes
33. Name*
34. Official Capacity*
36. Name
37. Official Capacity
39. Company Insight
41. Products and/or Services Offered*

    Please check applicable categories.

    1. Lawn Maintenance
    2. Junk and Debris Removal
    3. Board Ups
    4. Demolition
    5. Concrete Provider
    6. Asphalt Provider
    7. Construction
    8. Water Project Provider

    1. Sewer Project Provider
    2. Motor Vehicle Pool Services
    3. Police Equipment
    4. Fire Equipment
    5. Information Technology
    6. General Supplies
    7. Other
43. Other
44. Other
46. Payments
48. Do you agree to the City of Taylor net 30 payment schedule.*
    -- Select One --YesNo
50. Payment Types Accepted
52. City Issued Check*
    -- Select One --YesNo
53. Visa Credit Card*
    -- Select One --YesNo
55. Electronic Funds Transfer*
    -- Select One --YesNo
56. Automatic Clearing House*
    -- Select One --YesNo
58. Does the company hold one of the following registrations/certifications?

    Please check those which apply.

    1. SBA Certified Small Disadvantaged Business (DBE)
    2. Section 3 Business Certifications
    3. Minority Owned Business (MBE)
    4. Veteran Owned Business (VSOB)
    5. Service Disabled Veteran Owned (SDVOSB)
    6. Women Owned Business (WBE)
    7. Women Owned Small Business (WOSB)
    8. Economically Disadvantaged Women Owned Small Business (EDWOSB)
60. Third-party certification for categories above.
62. Does any employee of the City of Taylor have financial interest, solely of partially in this company?*
    -- Select One --YesNo
64. If the answer to the previous question is "yes'", state the nature of interest held.
66. Copy of company's W-9*
67. Company's Certificate of Insurance
69. Contractor or Business License
71. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
73. Electronic Signature
75. I certify that the information supplied herein (including all pages attached) is correct and that neither the applicant nor any person (or concern) in any connection with the applicant as a principal or officer, so far as is known, is now barred or otherwise declared ineligible by any public agency from bidding for furnishing, materials supplies, construction, or services to any agency thereof.
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77. Submit

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