10-Vendor Information Form - 2024.pdf
PDF 119 KB Posted
- Attached to
- Right to Know Compliance and Surveying Services State and local contract opportunity
- Solicitation number
- BC-RFP-25-019
- Issued by
- Bergen County, New Jersey
About this file
This document is a Vendor Information Form from the County of Bergen, Department of Administration and Finance, located in Hackensack, New Jersey. The form is designed for potential vendors to provide comprehensive company details, including basic contact information, business classification, and tax status. It requires vendors to input their company name, address, authorized official contact information, and indicates whether they prefer purchase orders to be emailed.
The form includes sections for both primary vendor information and a separate remittance address if different from the main contact details. Vendors are asked to classify their business type, such as small business, minority-owned, women-owned, or veteran-owned, and specify their IRS classification (e.g., C-Corp, S-Corp, Partnership, Limited Liability Corporation). The document concludes with a certification statement where the vendor can print their name and provide a signature, affirming the accuracy of the information submitted.
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Text version
COUNTY OF BERGEN
DEPARTMENT OF ADMINISTRATION AND FINANCE
DIVISION OF THE TREASURER
One Bergen County Plaza• Suite 501 • Hackensack, N.J. 07601-7076
(201) 336-6550 • (201 336-6595 James J. Tedesco, Ill County Executive
Jon Rheinhardt
CFO
Melissa Howard Treasurer
* - Required field
VENDOR INFORMATION FORM
Vendor Information (as displayed on W-9 form):
Company Name*:
Address*:
City*:
State*:
Zip Code*:
Name of Authorized Official*:
Phone Number*:
Email Address*:
Would you prefer that PO's to be emailed to the email address provided?
□Yes □No
Remittance Address: (if different than information above)
Pay-To-Name:
Pay-To-Address:
Pay-To-City:
Pay-To-State:
Pay-To-Zip:
Pay-to Attn:
Payment Email:
Business Classification:
Is your company a: * IRS Classification: *
□ Small Business □ Individual/ Sole proprietor
□ Minority Owned □ C-Corp
□ Women Owned □ S-Corp
□ Veteran Owned □ Partnership
□ Other: □ Trust/Estate
□ Not Applicable □ Limited Liability Corp - Corporation
□ Limited Liability Corp - S
Corporation
□ Limited Liability Corp - Partnership
□ Tax-Exempt Organization
I certify that the information provided on this form is true and accurate to the best of my knowledge.
Print Name: Signature:
File details come from the government source that posted it. Updated .