New Vendor Registration
Monroe County Purchasing Department Print Form
200 County Office Building
39 West Main Street
Submit by Email
Rochester, NY 14614
the completed form to Purchasing & Central Services (585-753-1104).
Vendor Name:
REMIT TO ADDRESS INFORMATION:
Number & Street:
Street 2:
City/Town: State: Zip: Country:
Phone (no spaces): Cell Number (no spaces):
PURCHASE ORDER ADDRESS INFORMATION:
Number & Street:
Street 2:
City/Town: State: Zip: Country:
Email: Fax:
VENDOR TAX INFORMATION (Either SSN or Federal Employer ID Number):
SSN: OR FEIN #:
MINORITY AND WOMEN'S BUSINESS ENTERPRISE INDICATOR:
Are you a minority- or woman-owned business?
Minority Business Enterprise (MBE) Minority/Women-Owned (MW)
Women-Owned Business Enterprise (WBE)
If yes, please enter the following: Certification Date:
AND
VETERAN BUSINESS INDICATOR:
Are you a veteran-owned business?
Veteran-Owned Business
Service Disabled Veteran-Owned Small Business (SDVOSB)
PURCHASING DATA:
Shipping Terms: (e.g., FOB Destination)
Salesperson:
Phone Number:
Vendor's Account Number:
INDICATE MATERIAL GROUP(S) ON PAGE TWO.
Please email (mcpurchasing@monroecounty.gov) or print and fax
Witholding Tax Code:
