6-Vendor Information Form.pdf
PDF 111 KB Posted
- Solicitation number
- BC-BID-25-48.1
- Issued by
- Bergen County, New Jersey
About this file
The document is a Vendor Information Form from the County of Bergen, Department of Administration and Finance, Division of the Treasurer, located in Hackensack, New Jersey. The form is designed to collect comprehensive vendor details for potential business relationships, including basic company information, contact details, and business classification. It requires vendors to provide their company name, address, authorized official's name, contact information, and preferences for purchase order communication.
The form includes sections for business classification, allowing vendors to identify their business type (such as small business, minority-owned, women-owned, or veteran-owned) and their IRS classification (including options like sole proprietorship, C-Corp, S-Corp, partnership, and limited liability corporations). Vendors must certify the accuracy of the information provided by printing their name and providing a signature. The form is part of Bergen County's vendor registration and documentation process, enabling the county to maintain accurate records for potential contractors and suppliers.
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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 .