The City of Greenville, SC
DATE
VENDOR APPLICATION
FIRST NAME LAST NAME
COMPANY NAME
DBA (if applicable)
PHYSICAL ADDRESS
CITY STATE ZIP
REMIT TO ADDRESS
CITY STATE ZIP
TELEPHONE NO. ( ) FAX NO. ( )
E-MAIL ADDRESS
FEDERAL ID NO. YEARS IN BUSINESS
CITY POINT OF CONTACT (Please specify your City point of contact & their Department):
MAJOR COMMODITY/SERVICE OFFERED
MINORITY STATUS (Required)
Enter appropriate letter in the box
A – African American Certified
B – Asian Certified
D – Veteran / Disabled Certified
F – Female Certified
G – Native American Certified
H – Hispanic Certified
N – None
S – Small Business
W – Woman owned
Y – Minority (to be used if not
Certified, Small Business or Woman owned)
PLEASE RETURN THIS INFORMATION TO: Your City contact.
City contact will submit to the City of Greenville, SC Purchasing Department for approval.
OFFICE USE ONLY
APPROVED
Purchasing Administrator Date
