Company Profile
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1COMPANY PROFILE
CITY OF AUSTIN VIN:
Company Name
Remit-to Mailing Address
Sales Mailing Address
City, State,Zip
City,State,Zip
Accounts Receivable contact:
Name of sales contact:
Phone (voice)
Fax:
Phone (voice)
Fax:
My firm is a:
Federal Taxpayer ID (Employer Identification Number):
Manufacturer
Dealership
Jobber/wholesaler
OR
Factory Rep
Retailer
Service provider
Social Security Number (if no EIN):
Business Structure:
Sole proprietorship
Partnership
Corporation
TAXPAYER ID NUMBER IS REQUIRED!
Minority/Woman-Owned Businesses. A minority-owned business enterprise (MBE) is one, which is owned, managed and controlled by minority persons (Asians,
African Americans, Hispanics, and Native Americans). A woman-owned business enterprise (WBE) is one, which is owned, managed and controlled by women.
This firm is:
Sex of majority owner/stockholder:
Ethnic group of majority/owner/stockholder
Not an M/WBE firm
Male
Asian
Native American
An M/WBE firm certified by the City of Austin
Female
African American
White
An M/WBE firm, but not certified by the City of Austin
Hispanic
Other
A DBE firm
CITY OF AUSTIN USE ONLY BELOW THIS LINE
Comment (DBA reference):
1099 Required (Y/N)
Hold checks (Y/N)
Alternate address/messages:
Rept-1 (Ethnicity/Sex code):
Rept-2 (Location Code):
Rept-3(MBE/WBE/DBE/OBE):
Rept-4 (credit cards/no)
Rept-5 (Vendor type code):
DSMBR classification:
Minority-owned Bus. Enterprise
Disadvantage Bus. Enterprise
DSMBR Cert. Thru:
Woman-Owned Bus. Enterprise
Other Bus. Enterprise
DSMBR Certified M/WBE (Y/N)
Small business (Y/N)
REQUIRED SIGNATURE APPROVALS
In State (Y/N)
Name Control
Purchasing Office Approval & Date
Accounts Payable Approval & Date
Date Purchasing entered into LGFS:
Purchasing Ofc initials:
DSMBR Approval & Date (required for ALL”Y” “9” Address Codes)
Submitted by (City employee):
Telephone
VEND action (check 1,2, or 3)
BE SURE TO COMPLETE VENDOR
1.Adding a new base vendor.
INFORMATION ON REVERSE, OR YOUR FIRM
2.Adding a new address code to existing base Vendor Code.
WILL NOT BE LISTED ON THE CITY’S LIST OF
3.Changing data within existing record.
VENDORS!!!
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Parent category: Business