Vendor Application

Vendor Application
Select the applicable option:*

New Vendor ApplicationCurrent Vendor Update
Are you a 1099 Vendor?*

Yes (Paid by Social Security Number)No (Paid by Tax ID Number)
Are you an E-verify employer?*

ApplicableExempt (Less than 25 employees)
E-verify employers must submit verification with application.
Upload E-verify Verification:

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Company Name:*
DBA:*
Purchase Order Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
Payment Terms:*
Do bid requests go to a different address than entered above?*

YesNo
Address for Bid Requests:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Remit To Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Inside Sales Representative Name:*

First NameLast Name
Inside Sales Representative Phone Number:*

Area CodePhone Number
Outside Sales Representative Name:*

First NameLast Name
Outside Sales Representative Phone Number:*

Area CodePhone Number
Individuals with authority to quote and/or sign contracts:
Name:*

First NameLast Name
Job TItle:*
Phone Number:*

Area CodePhone Number
Add second individual with authority to quote and/or sign contracts?*

YesNo
Name:

First NameLast Name
Job Title:
Phone Number:

Area CodePhone Number
Add third individual with authority to quote and/or sign contracts?

YesNo
Name:

First NameLast Name
Job Title:
Phone Number:

Area CodePhone Number
Do you have a City of Salisbury privilege license?*

YesNo
A copy of your privilege license must be uploaded:

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Are you an out of state vendor?*

YesNo
A copy of your NC Certificate of Authority must be uploaded:

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Describe your type of business:*
Business type:*

CorporationPartnershipIndividual
Date your business was established/founded:*

MonthDayYear
Date
Officers of corporation, partners, or members of firm (Name and Title):*
At the present time, or at any time during the last 12 months, has any owner, stock holder, employee or other person with an interest, either directly or indirectly, in the above company been connected in any official capacity with, or been employed by, the City of Salisbury?*

YesNo
Identify the connection to the City of Salisbury:
Are you able to receive payments by EFT?*

YesNo
Are you or an affiliate rated by Dunn and Bradstreet?*

YesNo
Your Dunn and Bradstreet rating:
List three (3) suppliers to your firm:
Supplier 1 Name:*
Supplier 1 Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supplier 1 Phone Number:*

Area CodePhone Number
Supplier 2 Name:*
Supplier 2 Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supplier 2 Phone Number:*

Area CodePhone Number
Supplier 3 Name:*
Supplier 3 Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supplier 3 Phone Number:*

Area CodePhone Number
List three (3) companies to whom you furnish products or service:
Company 1 Name:*
Company 1 Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company 1 Phone Number:*

Area CodePhone Number
Company 2 Name:*
Company 2 Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company 2 Phone Number:*

Area CodePhone Number
Company 3 Name:*
Company 3 Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company 3 Phone Number:*

Area CodePhone Number
ATTENTION MINORITY / WOMAN OWNED BUSINESS
The City of Salisbury, in a concerted effort with other local, state and federal agencies, actively seeks to identify minority businesses and offer them an equal opportunity to participate as providers of goods and services to the City. A minority business is defined as a business which, at minimum, is 51% owned and controlled by ethnic minority group members and/or women.
Are you a minority or woman owned business?*

YesNo
All minority owned businesses are requested to complete the following in the manner that bests describes their business. Please check all that apply:

African AmericanNative AmericanHispanic AmericanAsian AmericanWoman Owned
I CERTIFY THAT THE INFORMATION PROVIDED HERE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE:*

Enter Name and Title
A WORD TO POTENTIAL VENDORS - The City of Salisbury requires all purchases of $1000 or more to be authorized through the issuance of a City of Salisbury Purchase Order. Purchases less than $1000 (including freight and tax) may be charged by authorized City of Salisbury employees using our Purchasing Card. It is a vendor's responsibility to verify that individuals identifying themselves as City employees are employess in good standing. A single account should be established for the City - individual accounts by Department or Division are not recommended. Vendors who do not accept charge cards should invoice the City's Accounting Division at PO Box 479, Salisbury, NC 28145 or financeAP@salisburync.gov. The City is NOT exempt from paying sales and use taxes. Our Federal Taxpayer ID No. is 56-6000237. We are exempt from Federal Excise Tax. All prices should be quoted FOB Destination Prepaid Salisbury, NC.
Identify the commodities and services you can provide:*
Should be Empty: