Vendor Application Form - City of Hayward, California

This fillable "Vendor Application Form" is a document issued by the California Department of Finance specifically for California residents.

Download the PDF by clicking the link below and complete it directly in your browser or through the Adobe Desktop application.

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VENDOR APPLICATION FORM
__________________________________
Company Name:________________________________
(Legal Name)
Federal Tax ID#
___
__________________________________
Tax Payer Name:____________________________
(Legal Name)
Social Security #
PURCHASING INFORMATION
ACCOUNTS PAYABLE INFORMATION
_______________________________________________________
_____________________________________________
Address (Receipt of Order)
Address (Payment Remittance)
_______________________________________________________
_____________________________________________
City/State
Zip Code
City/State
Zip Code
_______________________________________________________
_____________________________________________
Contact Name
Contact Name
_______________________________________________________
_____________________________________________
Telephone #
Phone #
_______________________________________________________
_____________________________________________
Fax #
Fax #
_______________________________________________________
Payment Terms:_________________________________
E-mail Address
_____________________________________________
Standard Industry Code:_________________________
Web Address
____________________________________________________________________________________________________________
Commodity or Services Provided
(A cover letter on company letterhead and line cards may be included with this application)
Minority Owned? (Circle one)
Yes / No
(If yes, circle the applicable categories)
Female/Woman
African American
Asian American
Native American
Hispanic/Latin
Other (specify)_________________________
Business Data (Circle one)
Large Business
Small Business
Small Disadvantaged Business
Non-Profit
Woman-Owned
Does your company maintain a physical presence in the City of Hayward?
Yes____ No____
***PLEASE ATTACH A COPY OF YOUR COMPANY’S W-9 FORM TO THIS APPLICATION***
1
Department of Finance
V/C: ________
Purchasing Division
777 B Street, Hayward, CA 94541-5007
I/C: ________
Tel: 510/583-4800 Fax: 510/583-3600
Website: www.hayward-ca.gov
*For Purchasing Use Only
VENDOR APPLICATION FORM
__________________________________
Company Name:________________________________
(Legal Name)
Federal Tax ID#
___
__________________________________
Tax Payer Name:____________________________
(Legal Name)
Social Security #
PURCHASING INFORMATION
ACCOUNTS PAYABLE INFORMATION
_______________________________________________________
_____________________________________________
Address (Receipt of Order)
Address (Payment Remittance)
_______________________________________________________
_____________________________________________
City/State
Zip Code
City/State
Zip Code
_______________________________________________________
_____________________________________________
Contact Name
Contact Name
_______________________________________________________
_____________________________________________
Telephone #
Phone #
_______________________________________________________
_____________________________________________
Fax #
Fax #
_______________________________________________________
Payment Terms:_________________________________
E-mail Address
_____________________________________________
Standard Industry Code:_________________________
Web Address
____________________________________________________________________________________________________________
Commodity or Services Provided
(A cover letter on company letterhead and line cards may be included with this application)
Minority Owned? (Circle one)
Yes / No
(If yes, circle the applicable categories)
Female/Woman
African American
Asian American
Native American
Hispanic/Latin
Other (specify)_________________________
Business Data (Circle one)
Large Business
Small Business
Small Disadvantaged Business
Non-Profit
Woman-Owned
Does your company maintain a physical presence in the City of Hayward?
Yes____ No____
***PLEASE ATTACH A COPY OF YOUR COMPANY’S W-9 FORM TO THIS APPLICATION***
1
Department of Finance
V/C: ________
Purchasing Division
777 B Street, Hayward, CA 94541-5007
I/C: ________
Tel: 510/583-4800 Fax: 510/583-3600
Website: www.hayward-ca.gov
*For Purchasing Use Only
VENDOR APPLICATION FORM
Address (if different from above):________________________________________________________________
Describe (warehouse, sales office, administration office, plant, etc.):____________________________________
Type of business (Circle one) Corporation Partnership Individual Government Agency
How long have you been in business? __________
Are you incorporated? (Circle one) Yes / No.
Who are the principle owners? _________________________________________________________________
Who are some of your major customers? May we contact some of them for references? Yes / No
__________________________________________________________
_____________________________________________________
1. Company Name
Contact/Title
__________________________________________________________
_____________________________________________________
Address
Phone #
__________________________________________________________
_____________________________________________________
City/State
Zip Code
Fax #
__________________________________________________________
_____________________________________________________
2. Company Name
Contact/Title
__________________________________________________________
_____________________________________________________
Address
Phone #
__________________________________________________________
_____________________________________________________
City/State
Zip Code
Fax #
__________________________________________________________
_____________________________________________________
3. Company Name
Contact/Title
__________________________________________________________
_____________________________________________________
Address
Phone #
__________________________________________________________
_____________________________________________________
City/State
Zip Code
Fax #
Signature
Title
Date
2

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