Fillable City of Bridgeport Request for Vendor Identification Numbers (City of Bridgeport)

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City of Bridgeport Request for Vendor Identification Numbers (City of Bridgeport)

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The City of Bridgeport Request for Vendor Identification Numbers (City of Bridgeport) form is 2 pages long and contains:

  • 1 signature
  • 20 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Bridgeport

BROWSE CITY OF BRIDGEPORT (CT) FORMS

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City of Bridgeport 999 Broad Street, Bridgeport CT, 06604 Purchasing Department
City of Bridgeport
Request for Vendor
Identification Numbers and Certification
***Please Print and Complete Form in Full-***MANDATORY***
BUSINESS NAME: ________________________________________________________________
(As shown on your Federal Tax Return)
ALTERNATE NAME, IF APPLICABLE (Doing Business As): _______________________________________
Note: When more than one name is listed, the name registered under the EIN or SSN will be the first name listed.
TAX ID # (EIN OR SOCIAL SECURITY): ___________________________________________________________
MAILING ADDRESS: _________________________________________________________________________
CITY:________________________________STATE:_____________________ZIP CODE:___________________
CONTACT PERSON: ______________________________________ TITLE: ______________________________
TELEPHONE: ______________________________________ FAX: ___________________________________
WEBSITE (If any): ____________________________________________________________________________
E-MAIL ADDRESS (For Email Purchasing Order): ______________________________________________________
REMIT PAYMENT
(If different from above)
ATTENTION NAME: _________________________________________________________________________
MAILING ADDRESS: _________________________________________________________________________
PO BOX (if any)
CITY:________________________________STATE:_____________________ZIP CODE:__________________
TELEPHONE: _______________________________________ FAX: __________________________________
EMAIL 1: __________________________________________________________________________________
EMAIL 2: __________________________________________________________________________________
Add New Vendor
Update Existing Vendor
***INTERNAL USE ONLY***
City of Bridgeport 999 Broad Street, Bridgeport CT, 06604 Purchasing Department
VENDOR TYPE: GOODS SERVICES EMPLOYEE RENTAL NON-EMPLOYEE
Goods/Services to be Provided by Vendor: ___________________________________________________
Check Appropriate Box:
Individual/Sole Proprietor or
Single Member LLC C Corporation Partnership Trust/Estate
Limited Liability Company, enter the tax classification, S=S corporation, P=partnership
Tax Exempt Organizations Federal/State/Local Tax Exempt
Note: For s single-member LLC that is disregarded, do not check LLC: check the appropriate box in the line above for the tax
classification of the single-member owner.
Certified as (if applicable) Woman Owned African American Owned Hispanic Owned
Check appropriate box:
Asian/Pacific Native Indian/ Disabled Owned
Islander Owned Alaskan Owned
PRINT NAME: ______________________________________________________________________________
SIGNATURE OF US. PERSON: ________________________________ DATE: ____________________________
(of owner or officer by a U.S. Person)
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City of Bridgeport Request for Vendor Identification Numbers (City of Bridgeport)

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Completed 22 January 2021

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