4-Vendor Information Form 2024.pdf

87 KB Posted

Attached to
IFB - ST GEORGE INDUSTRIAL 2 MG TANK PROJECT
Solicitation number
24-180
Issued by
Washington County, Utah

About this file

Written by GovTribe AI ·

This document is a Vendor Information Form issued by the City of St. George, dated October 13, 2021. The form is a standard template designed to collect comprehensive contact and business information from potential vendors or contractors who wish to do business with the city. The form requires detailed input across multiple sections, including the legal business name, doing business as (DBA) name, website, primary remittance address, and full accounts receivable/credit contact details.

The form includes spaces for a primary contact's name, title, phone number, and email address, with a certification statement at the bottom where an authorized representative can sign, confirm the accuracy of the provided information, and grant authorization for its use. The document appears to be an administrative tool for establishing a vendor profile and maintaining current vendor information within the city's procurement system, with provisions for updating vendor details as needed.

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City of St. George Vendor Information Form

Revised 2021-10-13

LEGAL BUSINESS NAME: ______________________________________________________________

(as listed on W-9)

DBA and/or SUBSIDIARY NAME(S): ________________________________________________________

WEBSITE: ____________________________________________________________________________

PRIMARY REMITTANCE ADDRESS: _________________________________________________________

CITY: ___________________________________________ STATE: ______ ZIP: _____________

ACCOUNTS RECEIVABLE / CREDIT CONTACT INFORMATION

PRIMARY CONTACT NAME: _______________________________________________________________

PRIMARY CONTACT TITLE: _______________________________________________________________

PRIMARY CONTACT PHONE NUMBER: ______________________________________________________

PRIMARY CONTACT EMAIL ADDRESS: ______________________________________________________

I certify that all information on this form is true and complete. Authorization to utilize any of the above information is hereby given.

Authorized Signature Title Date

LEGAL BUSINESS NAME:
DBA andor SUBSIDIARY NAMES:
WEBSITE:
PRIMARY REMITTANCE ADDRESS:
CITY:
STATE:
ZIP:
PRIMARY CONTACT NAME:
PRIMARY CONTACT TITLE:
PRIMARY CONTACT PHONE NUMBER:
PRIMARY CONTACT EMAIL ADDRESS:
Title:
Date:

File details come from the government source that posted it. Updated .