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(For County Use Only)
Legal Vendor/Company Name
Doing Business As, If Different From Above
Contact Fax Number
Federal EIN or Social Security Number
Specify 1099 Category If Known
Please mark all that apply:
Please indicate if your company is certified by one or more of the following councils / agencies:
Please pick a category.
List Principal Products and/or services offered by your company.
Describe any sustainability or green initiatives your company is involved in. Does your company use any Green E or Green Seal products? If so, please list.
A valid County Purchase Order Number and/or Purchase Order must be received by vendor PRIOR to commencing production or services and must be referenced by number on your company’s invoice.
Please enter the purchase order or pricing address if different from above.
Contact Phone Number
Payment will be in either the form of a County issued check or authorized County credit card. If a purchase order is issued, payment shall be made in accordance to terms noted on purchase order after the occurrence of; a) receipt by County of supplier’s invoice, where invoice date cannot precede shipment date, for payment (which must reference the Purchase Order Number); and b) completion and delivery of all work to be performed and goods to be delivered.
Please enter the remittance address below if difference from above.
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S resident alien).
Electronic Signature: By typing your name here your are acknowledging that all of the above statements are true. Signing this document also affirms that the forms are true and correct and that your company has received and accepts the terms of doing business with the County of Lancaster as stated within this website.
After submitting the vendor registration form please follow the link below to the Public Purchase website to retrieve a copy of the bid. You will also need to register with Public Purchase.
This field is not part of the form submission.
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