6-Vendor InformationForm.pdf

This 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 engagement, including company information, contact details, remittance address, and business classification. It requires vendors to provide their complete company information as displayed on a W-9 form, including company name, address, contact information for an authorized official, and preferences for purchase order communication.

The form includes a section for business classification where vendors can identify their business type (such as small business, minority-owned, women-owned, or veteran-owned) and their IRS classification (including options like individual/sole proprietor, C-Corp, S-Corp, partnership, etc.). Vendors are required to certify the accuracy of the information provided and must sign the form. The document is overseen by County Executive James J. Tedesco, III, and includes key financial personnel like Jon Rheinhardt (CFO) and Melissa Howard (Treasurer), indicating it is an official county procurement document for vendor registration and information collection.