GC New Vendor Registration GC


 
Application Date:
Type of Application:


 
Sales Address:

Name:
Address:
City:
State:
Zip:
Telephone:
Fax:



Payment Address:

Name:
Address:
City:
State:
Zip:
Telephone:


 
Contact Person(s) for Bids/Quotes:

Primary Contact Name:
Title:
Phone:
Fax:
Email:
 
Secondary Contact Name:
Title:
Phone:
Fax:
Email:



Organization Info:

Type of Organization:
If Corporation, Incorporated under the Laws of the State of :
Federal Employer Identification or Social Security Number:
Dun & Bradstreet Number:
How long in present business (years):
Located in Garrett County?
Type of Business:
 

 
Minority Business:

Minority Owned Business?
If yes, please select from the list:
State of Maryland Minority Business Certification Number:
 

 
Vendor Commodity Information:




 Extra Notes: