Seal of the Purchasing Department

Vendor Application

* Required fields

*Company Name:

*Address:

*City:

*State:

*Zip:

*Telephone No: (numbers only)

Fax No: (If Available, numbers only)

*Email:

Website: (If Available)

County License No:

DIR Number:

Any vendor participating in a public works project costing more than $1000 has to be registered with the State's DIR (Dept of Industrial Relations)

*Local Rerpresentative:

Name:

Email:

*Commodity Type: (Don't use code please)