Vendor Information Request Form

Please complete all information requested

Business Information and Classification

Tax ID:*
Name:*
Please enter your business name EXACTLY as it appears on the postcard.
Postcard #:*
Please see your postcard # located on the back of the postcard, near the web address.
DBA:
Address:*
Phone:*
Email:*
Business Classification:*
EDGE
WBE
VBE
SBA
LOCAL
DBE
MBE
N/A

National Institute of Government Purchasing (NIGP Codes)*

Selected NIGP Codes:

Procurement (Purchase Order) Information

Additional contact information can be added in Phase 2.
Contact Name:*
Job Title:*
Department:*
Email:*
In the future, Purchase Orders will ONLY be communicated by e-mail.
Phone:*
Cell:
Address:

Payment Method Information (Card Specific)

Card Accepted:*
Yes
No
Card Limits:*
Yes
No
$
Card Fee:*
Yes
No
$
Payment Options (Check all that apply):*
Online
Phone
Email

For questions, please call Lucas County Purchasing at 419-213-4519