VENDOR INFORMATION FORM
You may complete the following Vendor Information Form by printing out the form, completing the
appropriate information along with signature, and submit your application by mail or fax.
Remittance Address: (If different)
The undersigned certifies that the information contained herein is correct. I understand that the form must be complete or
it will be returned. Vendors are added to the file based on the information contained in this form. Misrepresentation may
be cause for removal of my firm's name from the Town's vendor list.
Above signature (typed):
Check those that apply to your firm:
____ Minority owned (at least 51%)
Is your firm incorporated?
____ Female owned (at least 51%)
____ Physically handicapped owned (at least 51%)
What is your Federal Identification Number or Social Security Number? _________________________
Are you a governmental or a not-for-profit entity? _____ (Y/N)
What is the nature of your business? Strictly sale of merchandise
Provider of services, including parts/supplies
Town of Cary Privilege License Number _______________ Not yet applied for ______________ (ü)
Exempt for reasons of:______________________________________________________________
After placement on our vendor lists, a vendor's repeated failure to respond to the Town's inquiries in kind (submission of written
response if written request was sent or responding by telephone if the inquiry was made by telephone) either to bid or to advise that
your firm is unable to bid will be understood by the Town of Cary to indicate a lack of interest and your concurrence in the removal of
your firm's name from the Town's vendor lists.
Please check the goods and services that are listed on the following page that your firm would be interested in supplying and return
this form to:
Town of Cary
P. O. Box 8005
Cary, NC 27512-8005
Telephone: 919-469-4105 // Fax: 919-469-4377