Company Information:

Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
URL

If Applicable, DBA:

Business Located in Franklin County:

Yes
No

Bid Mailing Address (if different than above):

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Federal I.D. #:

Type of Operation (check all that apply):

Individual
Partnership
Corporation
Manufacturer
Retail Dealer
Distributor
Agent/Broker

Type of Organization:for definitions click on the links below

Small and Emerging Business ( SEB)

(SEB must print-out, fill-out and MAIL-In SEB Affidavit)

Disadvantaged Business Enterprise (DBE)
Women Business Enterprise (WBE)
Minority Business Enterprise (MBE)

Contact Primary:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail

Name
Title
Street Address
Address cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail

Type of Registration (check all that apply):

New Registration
Change in Address
Add Commodity or Service
Delete Commodity or Service

NIGP General Commodity/Service Area:

Enter ALL 3 digit code/s that apply to your business (see below):

use commas to separate (example -> 100, 101, 102)

See Commodity Codes (PDF)