* Denotes required field.
Company Name*
If applicable, DBA
Address*
City*
State* Please Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip*
Web Site Address
Business Is Located in Franklin County Yes No
Federal ID Number*
Type of Operation (check all that apply) Individual Partnership Corporation Manufacturer Retail Dealer Distributor Agent/Broker
Type of Organization (For definitions, click titles. Check all that apply.) Disadvantaged Business Enterprise (DBE) Minority Business Enterprise (MBE) Small and Emerging Business (SEB) Women Business Enterprise (WBE)
Vendors submitting this registration form may indicate one or more of the following types of businesses when registering with Franklin County. Designation of the groups below is a “self-certifying” process. Franklin County may request verification of self-certification prior to or after the award or any contract.
Franklin County reserves the right to terminate and/or not do business with any individual or firm that abuses the self-certifying process.
NIGP General Commodity/Service Area* Enter all codes that apply to your business. Use commas to separate (example -> 100, 101, 102) See Commodity Codes [Opens in New Window]
Contact Name*
Please note that you only need to provide your Email address or your phone number.
Email Address*
Phone Number (With Area Code)*
Fax
