RFQ_24_25-10_Attachment_5_-_Vendor_Information_Form_12_Fillable_Revised_11_30_2022.pdf
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- Solicitation number
- RFQ 24/25-10
- Issued by
- Seminole County, Florida
About this file
This is a Vendor Information Form used by the City of Sanford, Florida, for registering vendors interested in bidding on government contracts and procurement opportunities. The form collects comprehensive vendor registration details including remittance information, authorized vendor addresses, contact information, Federal ID numbers, and W-9 form documentation. Vendors must complete all required sections, including confirmation of registration from the Florida Department of State (https://dos.myflorida.com), and provide descriptions of services offered with corresponding commodity codes. The form includes sections for city staff use only to assign appropriate commodity and sub-commodity classifications. The deadline for submission is not specified in this document, as it is a template form with instructions that responses should be submitted by mail, fax, or email as instructed by the requesting individual. The form was last updated in November 2022.
The document also includes an Electronic Funds Transfer (EFT) enrollment option for vendors who wish to receive payments through electronic means, requiring bank information including ABA routing numbers and account details. Vendors electing EFT will receive an initial PRE-NOTE transaction with zero balance sent to a designated email address. No specific pricing terms, set-asides, or contract funding information is contained within this vendor registration form itself, as it functions solely as a vehicle for vendor qualification and payment processing setup. The form requires an authorized vendor signature and emphasizes that incomplete submissions will not be accepted by the Purchasing Division.
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Text version
Select one of the above
Remittance Name
Address P.O. Box or Street Address
City State Zip
Tel Fax: Contact
Federal I.D. No. - Social Security No_______-______-________
Name on Checks Name on Checks Required
Vendor Name
Address P.O. Box or Street Address
City State Zip
Country Tel Fax
Contact Email
Web Address
Vendor Name
Address P.O. Box or Street Address
City State Zip
Tel Fax Contact
Email address Web Address
►►NOTE: ALL ABOVE SECTIONS MUST COMPLETED AND INCLUDE A CONFIRMATION OR
REGISTRATION FROM HTTPS://DOS.MYFLORIDA.COM AND W-9 FORM, OPTION FOR ACH PAYMENT.
NOTE: COMPLETION INSTRUCTIONS: Clear copies, incomplete forms will not be accepted. Please complete these forms and return by either Mail, Fax or Email to address as instructed by the requesting individual: Attention
Updated 11/2022
NEW -CHANGE- VENDOR #VENDOR INFORMATION FORM
VENDOR AUTHORIZED SIGNATURE MUST have signature!
Vendor Signature: ___________________________ Date
Display Purchase Order Information
Display Vendor Bid Information https://dos.myflorida.com/
. Vendor: Describe what type of services you provide below; include commodity codes.
FOR CITY STAFF USE ONLY: Must be completed by City Staff only!
Please use the H.T.E or the City's intranet to get the commodities and sub-commodities write the number below that pertains to this vendor submit this with your vendor form. Incomplete forms will be forwarded to the appropriate departments. Thank you, Purchasing Division.
Commodity Sub-Commodity
Must be completed by the Department:
Requested by ______________________________________________________________________________
Dept./Division __________________________________________________ Date: ____________________
Electronic Funds Transfer (EFT) Enrollment Form If you wish to enroll in EFT you MUST fill out the below information
Bank Name:
Phone Number: ABA #
Account #________________________________________________________________________
Vendor Name:
Email address:
Email address used for payment notifications: Required
The first biweekly EFT will be a PRE-NOTE, which will be sent to the above email address with a zero balance. Please provide the City with an updated email address should you have any staff changes in the future.
\\SAN-CH-PRN\Finance_Dept\Purchasing\A-Purchasing Docs\Vendor Info_Tax Exempt_CityW9 Revised 11/30/2022 file://SAN-CH-PRN/Finance_Dept/Purchasing/A-Purchasing%20Docs/Vendor%20Info_Tax%20Exempt_CityW9
| Select one of the above |
| Updated 11/2022 |
| If you wish to enroll in EFT you MUST fill out the below information |
| Remittance Name: |
| Address: |
| City: |
| State: |
| Zip: |
| Tel: |
| Fax: |
| Contact: |
| Email: |
| Federal ID No: |
| undefined: |
| Name on Checks: |
| Vendor Name: |
| Address_2: |
| City_2: |
| State_2: |
| Zip_2: |
| Country: |
| Tel_2: |
| Fax_2: |
| Contact_2: |
| Email_2: |
| Web Address: |
| Vendor Name_2: |
| Address_3: |
| City_3: |
| State_3: |
| Zip_3: |
| Tel_3: |
| Fax_3: |
| Contact_3: |
| Email address: |
| Web Address_2: |
| Date: |
| Vendor Describe what type of services you provide below include commodity codes 1: |
| Vendor Describe what type of services you provide below include commodity codes 2: |
| undefined_2: |
| FOR CITY STAFF USE ONLY Must be completed by City Staff only: |
| Commodity 1: |
| Commodity 2: |
| Commodity 3: |
| Commodity 4: |
| Commodity 5: |
| Commodity 6: |
| Commodity 7: |
| Commodity 8: |
| Commodity 9: |
| Commodity 10: |
| Commodity 11: |
| undefined_3: |
| undefined_4: |
| undefined_5: |
| undefined_6: |
| undefined_7: |
| undefined_8: |
| undefined_9: |
| undefined_10: |
| undefined_11: |
| undefined_12: |
| undefined_13: |
| Requested by: |
| DeptDivision: |
| Date_2: |
| Bank Name: |
| Phone Number: |
| ABA: |
| Account: |
| Vendor Name_3: |
| Email address_2: |
| complete these forms and return by either Mail Fax or Email to address as instructed by the: |
| Check Box2: Off |
| Check Box3: Off |
| Text4: |
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