VENDOR APPLICATION
Town of Wake Forest
234 Friendship Chapel Road
Wake Forest, NC 27587
Phone: (919) 435-9474
Fax: (919) 435-9488
Please Type or Print Legibly
Federal ID # ________________________________ SS # ____________________________ Vendor # __________________
PHYSICAL ADDRESS PAY ADDRESS
Street
Street
Street
Post Office Box
City
City
State Zip Code
State Zip Code
CONTACT PERSON
TELEPHONE NUMBER FAX NUMBER
YEAR ESTABLISHED
TERMS DISCOUNT
CONTRACTOR’S LICENSE # (if applicable)
SIGNATURE
EMAIL ADDRESS:
This firm certifies that it is a: (if applicable)
Disabled Minority Business Enterprise Women Business Enterprise
To qualify for MWBE status, 51% of the company must be owned and controlled by minority groups or women. For the purpose of this definition,
minority group members are Black Americans, Hispanic Americans, American Indians and/or American Women. To qualify for Disabled status,
51% of the company must be owned and controlled by disabled persons.
Product(s) and/or Service(s)
Please list the type product(s) and/or Service(s) that your company can provide.
_________________________ _________________________ _________________________
_________________________ _________________________ _________________________
________________________________ _________________________________ _________________________________
Date
Vendor Name
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signature
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