I. Business Information
Vendor/Business Pay Application
II. Tax Filing Status
Check the box that applies to your business and complete the appropriate fields below.
Individual / Sole Proprietor Non-Profit Organization Partnership Corporation
Social Security # Federal Tax ID # DUNS #
III. Business Type
Check if any box applies to your business and enter the certification number.
Local Business DBE
Provide mailing address for payments if different than the above address.
City State Zip Code
V. Business License Information
Provide information for all that apply.
Florida State Certified License #
Florida State Registration License #
Florida Local Business Tax Receipt # Lee County Competency (Contractor) License #
I hereby certify that the information supplied herein is correct:
Lee County Board of County Commissioners - Procurement Management
2115 Second Street, 1st Floor - Fort Myers, FL 33901
PO Box 398 - Fort Myers, FL 33902-0398
Phone: (239) 533-8881