Vendor Application Form - City Of Hayward
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2VENDOR APPLICATION FORM
__________________________________
Company Name:________________________________
(Legal Name)
Federal Tax ID#
___
__________________________________
Tax Payer Name:____________________________
(Legal Name)
Social Security #
PURCHASING INFORMATION
ACCOUNTS PAYABLE INFORMATION
_______________________________________________________
_____________________________________________
Address (Receipt of Order)
Address (Payment Remittance)
_______________________________________________________
_____________________________________________
City/State
Zip Code
City/State
Zip Code
_______________________________________________________
_____________________________________________
Contact Name
Contact Name
_______________________________________________________
_____________________________________________
Telephone #
Phone #
_______________________________________________________
_____________________________________________
Fax #
Fax #
_______________________________________________________
Payment Terms:_________________________________
E-mail Address
_____________________________________________
Standard Industry Code:_________________________
Web Address
____________________________________________________________________________________________________________
Commodity or Services Provided
(A cover letter on company letterhead and line cards may be included with this application)
Minority Owned? (Circle one)
Yes / No
(If yes, circle the applicable categories)
Female/Woman
African American
Asian American
Native American
Hispanic/Latin
Other (specify)_________________________
Business Data (Circle one)
Large Business
Small Business
Small Disadvantaged Business
Non-Profit
Woman-Owned
Does your company maintain a physical presence in the City of Hayward?
Yes____ No____
***PLEASE ATTACH A COPY OF YOUR COMPANY’S W-9 FORM TO THIS APPLICATION***
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Department of Finance
V/C: ________
Purchasing Division
777 B Street, Hayward, CA 94541-5007
I/C: ________
Tel: 510/583-4800 Fax: 510/583-3600
Website:
*For Purchasing Use Only
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Parent category: Business