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Business Vendor Registration Form

Registering with the City helps connect you and City staff, improving opportunities for us to do business together.  Please complete and submit the form below, so that we can add you to our records.

Company Information
(Required)
Please enter your parent company's name.
If your company uses a trading-as name, please enter it below.
(Required)
Please enter your company's billing, street address.
Please enter additional information pertaining to your company's billing address (e.g. ATTN: Billing Department).
(Required)
Please enter the city portion of your company's billing address.
(Required)
Please select the state/province portion of your company's billing address.
(Required)
Please select the country portion of your company's billing address.
(Required)
Please enter the zip code portion of your company's billing address. Zip code+4 is optional.
(Required)
Please enter your company's mailing address street.
Please enter additional information pertaining to your company's mailing address (e.g. ATTN: General Information).
(Required)
Please enter the city portion of your company's mailing address.
(Required)
Please select the state/province portion of your company's mailing address.
(Required)
Please select the country portion of your company's mailing address.
(Required)
Please select the zip code portion of your company's mailing address. Zip code+4 is optional.
(Required)
Please enter the name of your company's point of contact.
Please enter the point of contact's title.
(Required)
Please enter a phone number where you can be reached (e.g. 123-555-1234).
(Required)
Please enter your company's fax number (e.g. 123-555-1234).
(Required)
Please enter a point of contact e-mail address.
Please enter the full URL for your company's website, including the http:// prefix (e.g. http://www.mycompany.com).
(Required)
Please select the type that best describes your company's organization.
(Required)
Please select what type of product your company sells.


Please indicate if you are a small, woman-owned, or minority-owned business. A small business employs less than 50, realizes gross annual sales of less than $2 million, and is independently owned and operated (not a subsidiary of another firm). A Minority Business is any firm in which minority persons collectively own and share in earnings of 51 percent (51%) or more of the firm. Minority means Black, Hispanic, Asian, Pacific Islander, American Indian, Alaskan Native, and Women, regardless of race or ethnicity.
If your firm is owned by a minority, please indicate the category below which best denotes your minority status. Note: Fraudulent or knowing, wrongful, or willful action taken to obtain certification as a Minority Business Enterprise is punishable as a Class I Misdemeanor.
Veterans wishing to apply for service disabled veteran status must first seek eligibility certification from the Department of Veteran Services by calling (540) 857-7101 or visiting the DVS website at www.virginiaforveterans.com. Please indicate if your business is certified as a Service Disabled Veteran Business.


If applicable, please enter your Virginia Department of Minority Business Enterprises certification number.
If applicable, please enter the expiration date of your Virginia Department of Minority Business Enterprises certification.
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Please enter your Social Security Number excluding dashes (e.g. 123456789). A Social Security Number and/or Federal Identification Number is required.
Please enter your Federal Identification Number excluding dashes(e.g. 123456789). A Federal Identification Number or Social Security Number is required.
(Required)
Please select at least one preferred method for receiving purchasing information and purchase orders.
Product/Service Information
Please identify equipment, supplies, materials and/or services on which you wish to bid.
(Required)
To select more than one option in the list, hold down the control key (CTRL) or command key (for Mac users) and then click to select/deselect options.
W-9 Submittal Requirement
Within twenty-four (24) hours of sending this Vendor Registration form, you must provide the City with a copy of your W-9. Failure to provide a completed W-9 form may result in payment witholdings. Please indicate the method you will use to deliver the W-9 to us (You must select one of the following):
(Required)



Submitter Information
(Required)
Please enter your full name (e.g. John Smith).
(Required)
Please enter your title (e.g. CEO, president, buyer)
(Required)
Please enter your e-mail address (e.g. jsmith@mycompany.com)
(Required)
To help stop spam, please enter the word "human" in all capital letters.
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