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gadsden county

New Vendor Information

If you are a new vendor with Gadsden County, this form must be completed and returned to Management Services to be added to the Vendor List.

* Denotes a required field

Firm Name*

Principal Contact*

Email Address

Work Phone*

Cell Phone*


Company Web Address

Address *

City*

State*

ZIP*

Second portion of ZIP Code is optional.

Main Phone*


Is the principal contact listed above authorized to sign bids, contracts and checks?


If no, list the name of the individual who has such authority

Federal I.D.*

Occupational License No.*

Primary Type of Business: Manufacturer Contractor/ Distributor*

Product to be provided/sold*

Firm/Company type: Sole Proprietorship/Partnership/Corporation/Other*

Is your company a Certified: Woman-owned/African-American/ Hispanic/Asian American/Native American/Native Alaskan

Terms of Payment*

Bonding Capability*

Does your firm currently cover all employees with Workman's Compensation insurance?*


Are any officers, owners, partners or employees (or employee family) an employee of Gadsden County Board of County Commissioners?*


If the above answer is Yes, please identify that person and their position with the County.


Certification: I certify that the information supplied herein, including all pages attaches, is correct and that neither the applicant nor any person(or concern) in any connection with the applicant is a principal officer so far as known, is now debarred*

 I certify

Name*

Date*