Weld County Vendor Registration by PermitDocsPrivate

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									WELD COUNTY GOVERNMENT                          THIS SPACE FOR USE BY AGENGY
915 10TH STREET                                 VENDOR NUMBER @______________________
P O BOX 758                                     ACCEPTANCE DATE: _____________________
GREELEY CO 80632                                BY: _______________________________________
PHONE: 970-356-4000 x4222 OR x4223              DATE RECEIVED: _________________________
FAX: 970-336-7226
WEBSITE: www.co.weld.co.us
EMAIL: mwalters@co.weld.co.us
          reverett@co.weld.co.us

                        VENDOR’S APPLICATION

COMPANY NAME: ___________________________________________________

CONTACT PERSON: __________________________________________________

BUSINESS ADDRESS: _________________________________________________

CITY/STATE/ZIP CODE: ______________________________________________

REMITTANCE ADDRESS: (IF DIFFERENT THAN BUSINESS ADDRESS):

______________________________________________________________________

PHONE: __________________________ FAX: _____________________________

FIN# OR SS#: _______________________ TERMS OF SALE: ________________

BUSINESS HOURS: ____________________________________________________
     TYPE OF ORGANIZATION:
     PARTNERSHIP_______, CORPORATION_______, OTHER ________________
                            UNDER LAWS OF STATE OF ________

      TYPE OF MINORITY OWNED BUSINESS:
      WOMAN OWNED______, MINORITY OWNED______, OTHER_______________

PERSON (S) AUTHORIZED TO SIGN BIDS, OFFERS, & CONTRACTS.


     ***CHECK ITEM (S) ON THE ATTACHED COMMODITY LIST FOR THE
        PRODUCTS OR SERVICE, ETC. YOUR COMPANY PROVIDES***
                          COMMODITIES

APPLIANCES               _____   MEDICAL/NURSING/EMT       _____
ASPHALT                  _____   MICROGRAPHIC              _____
AUDITING                 _____   MOSQUITO SPRAYING/ETC.    _____
AUTO EQUIP/SUPPLIES      _____   OFFICE EQUIPMENT          _____
AUDIOVISUAL EQUIP.       _____   OFFICE FORMS              _____
BUILDINGS                _____   OFFICE SUPPLIES           _____
BOOKS                    _____   PAINT                     _____
BRIDGES                  _____         TRAFFIC PAINT       _____
COMPUTERS                _____   PAPER                     _____
CHEMICALS                _____   PEST CONTROL              _____
CLOTHING                 _____   PHOTOGRAPHIC              _____
COMMUNICATION            _____   PRINTING                  _____
CONCRETE                 _____   PLUMBING & HVAC           _____
CONSTRUCTION             _____   PROFFESSIONAL SERVICES
COPIERS                  _____         ELEVATOR            _____
DE-ICING MATERIAL        _____         TRASH               _____
ELECTRICAL               _____         BANKING             _____
ELECTRONICS              _____         AUDITING            _____
EMBLEMS                  _____         SECURITY            _____
ENGINEERING              _____         WINDOW CLEANING     _____
ENVIRONMENTAL            _____         FOOD SERVICES       _____
EQUIPMENT                _____         MEDICAL SERVICES    _____
FAXES                    _____         CUSTODIAL           _____
FLAGS                    _____         SURVEYING           _____
FLOORS                   _____         ARCHITECT           _____
FOODS                    _____         CONTRACTORS         _____
FURNITURE                _____   RECYCLING                 _____
FUEL                     _____   REPAIR & MAINTENANCE      _____
GASES                    _____   ROAD CONSTRUCTION         _____
GLASS                    _____   SAFETY EQUIP/SUPPLY       _____
GRAVEL HAULING           _____   SALES/SALVAGE             _____
GUNS ETC.                _____   SCHOOL SUPPLIES           _____
HHW                      _____   SEEDING                   _____
HIGHWAY                  _____   SHOP EQUIPMENT/SUPPLIES   _____
HARDWARE                 _____   SIGNS                     _____
HEALTH                   _____   STEEL                     _____
JAIL SUPPLIES            _____   TELEPHONE                 _____
JAIL CLOTHING            _____   TEXTILES                  _____
JAIL BEDDING             _____   TONER                     _____
JAIL EQUIPMENT/FURNITURE _____   TOOLS                     _____
JANITORIAL SUPPLIES      _____   VEHICLES                  _____
KITCHEN SUPPLIES         _____   WINDOW COVERINGS          _____
LANDSCAPING              _____   WINDOW REPLACEMENT        _____
LAW ENFORCEMENT          _____   WELDING SUPPLIES          _____
LABORATORY               _____   OTHER….PLEASE SPECIFY:
LEASES                   _____
LUMBER                   _____
LAUNDRY                  _____
MAGNESIUM CHLORIDE       _____

								
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