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Finance and Management Agency Purchasing Section 150 Frank H. Ogawa Plaza, Suite 6223 Oakland, CA 94612 Phone: (510) 238-7566 Fax: (510) 238-7568

Vendor Registration Application
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1. Company Name and Address For Receiving Bids and Purchase Orders: If address is correct, please check ( ) box.

If the above address is NOT correct, please print any changes or corrections in the space below.

Company Name:
Address:
City:

State:

Zip Code:

(Must Provide Zip, Plus Four)

2. Vendor Contact Information:

Please print only one department/individual to contact regarding Bids/Purchase Orders

Contact Person/Department:
Telephone No:
Fax No:

Email:

Federal Employer ID Number (W-9 Taxpayer ID Application)

or

Social Security Number (if individual)

4. Organization Type (Check Only One):

Individual ______(I)	Partnership ______(P)	Non-Profit ______(N)
Corporation ______(C)	Joint-Venture ______(J)	Other ______(O)