5-Vendor InformationForm.pdf

This document is a Vendor Information Form from the County of Bergen, Department of Administration and Finance, specifically from the Division of the Treasurer located in Hackensack, New Jersey. The form is designed for potential vendors to provide comprehensive business and contact information, with multiple required fields to capture essential details about the company seeking to do business with the county. The form includes sections for basic vendor information (such as company name, address, contact details), remittance address specifics, and a business classification section where vendors can indicate their business type and IRS classification.

The form allows vendors to self-identify their business characteristics, including whether they are a small business, minority-owned, women-owned, or veteran-owned enterprise, and provides options for various IRS classifications like individual/sole proprietor, C-Corp, S-Corp, partnership, and others. At the bottom of the form, there is a certification statement where the vendor must print their name and provide a signature, attesting to the accuracy of the information submitted. The document is signed by James J. Tedesco, III as County Executive and Jon Rheinhardt as CFO, with Melissa Howard listed as Treasurer, lending official credibility to the vendor registration process.