Sedgwick County Purchasing Vendor Application

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SEDGWICK COUNTY PURCHASING DEPARTMENT
VENDOR APPLICATION

CHECK HERE IF THIS IS FOR CHANGE OF ADDRESS ONLY

SECTION 1: Business Name and Physical Address:

Company Name:
Street Address:
City / State / Zip:
Phone:
Fax:
E-Mail Address:
Corporate E-Mail Address:
Internet Address:

WILL PAYMENTS BE SENT TO A DIFFERENT ADDRESS? No Yes

SECTION 2: Mailing Address for Payments (if different):

Street Address:

City, State & Zip:

SECTION 3: Please Provide 1099 Reporting Number:

Federal ID Number:

~or~
SSN:

1099 Business Name:

SECTION 4: Please check the appropriate box describing your business type:

Individual / Sole Proprietor
Corporation
Partnership
LLC
Other

SECTION 5: Key Personnel to be Contacted by County Staff

Owner/Manager/Contact Person:
Orders and/or Delivery Info:

Name: Name:

Email: Email:

Phone: Phone:

Fax: Fax:

SECTION 6: Minority Owned Business?

If Yes:

SECTION 7: Additional Services/Commodities:

Please describe additional services/commodities that your company can provide that you wish your organization to be notified of when a Request for Bid or Quotation becomes available.

After we have received the Vendor Application, we will confirm your submission by way of e-mail correspondence. Thank you for your time.


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