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Register as a Vendor

2. Company Name*

4. Company Street Address*

6. City

7. State

8. Zip Code

10. County

11. Country

13. Email Address*

14. Fax Number

18. Remittance / Billing Address*

20. City

21. State

22. Zip Code

24. County

25. Country

27. Billing Contact

29. Name*

30. Job Title*

31. Phone Number

32. Email*

34. Sales Contact

36. Name*

37. Job Title*

38. Phone Number*

39. Email*

41. Type of Business
    -- Select One --Contact LaborEducation Services (Training)Equipment SalesLegalMedical ServicesRentalRepairs and ServicesSuppliesOther

    As shown on 1099, used for reporting purposes

42. If "Other", please note:

46. Items your firm wishes to quote for bidder list:*

50. Minority Business Certification*

    Minority group members are Black Americans, Hispanic Americans, Asian-Pacific Americans, Native Americans and women. A minority business enterprise is defined as at least 51% of which is owned by a majority group member, or in case of publicly owned businesses, at least 51% of the stock is owned by minority group members. The wife or spouse being a 51% owner in accord with the State of Texas Statutes of Community property is not a factor as the intent is to measure the participation of women as owners of businesses in their own right. The submitter certifies that his/her firm:

    1. Is a minority owned business enterprise
    2. Is not a minority owned business enterprise
52. Please specify minority classification owner as indicated:

56. To receive a copy of your submission, please fill out your email address before submitting:

Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field