Vendor Application

Select the applicable option: *

New Vendor Application Current Vendor Update

Are you a 1099 Vendor? *

Yes (Paid by Social Security Number) No (Paid by Tax ID Number)

Are you an E-verify employer? *

Applicable Exempt (Less than 25 employees)

E-verify employers must submit verification with application.

Upload E-verify Verification:

Browse Files

Company Name: *

DBA: *

Purchase Order Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email: *

example@example.com

Payment Terms: *

Do bid requests go to a different address than entered above? *

Yes No

Address for Bid Requests:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Remit To Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Inside Sales Representative Name: *

First Name Last Name

Inside Sales Representative Phone Number: *

Area Code Phone Number

Outside Sales Representative Name: *

First Name Last Name

Outside Sales Representative Phone Number: *

Area Code Phone Number

Individuals with authority to quote and/or sign contracts:

Name: *

First Name Last Name

Job TItle: *

Phone Number: *

Area Code Phone Number

Add second individual with authority to quote and/or sign contracts? *

Yes No

Name:

First Name Last Name

Job Title:

Phone Number:

Area Code Phone Number

Add third individual with authority to quote and/or sign contracts?

Yes No

Name:

First Name Last Name

Job Title:

Phone Number:

Area Code Phone Number

Do you have a City of Salisbury privilege license? *

Yes No

A copy of your privilege license must be uploaded:

Browse Files

Are you an out of state vendor? *

Yes No

A copy of your NC Certificate of Authority must be uploaded:

Browse Files

Describe your type of business: *

Business type: *

Corporation Partnership Individual

Date your business was established/founded: *

Date

Officers of corporation, partners, or members of firm (Name and Title): *

At the present time, or at any time during the last 12 months, has any owner, stock holder, employee or other person with an interest, either directly or indirectly, in the above company been connected in any official capacity with, or been employed by, the City of Salisbury? *

Yes No

Identify the connection to the City of Salisbury:

Are you able to receive payments by EFT? *

Yes No

Are you or an affiliate rated by Dunn and Bradstreet? *

Yes No

Your Dunn and Bradstreet rating:

List three (3) suppliers to your firm:

Supplier 1 Name: *

Supplier 1 Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Supplier 1 Phone Number: *

Area Code Phone Number

Supplier 2 Name: *

Supplier 2 Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Supplier 2 Phone Number: *

Area Code Phone Number

Supplier 3 Name: *

Supplier 3 Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Supplier 3 Phone Number: *

Area Code Phone Number

List three (3) companies to whom you furnish products or service:

Company 1 Name: *

Company 1 Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Company 1 Phone Number: *

Area Code Phone Number

Company 2 Name: *

Company 2 Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Company 2 Phone Number: *

Area Code Phone Number

Company 3 Name: *

Company 3 Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Company 3 Phone Number: *

Area Code Phone Number

ATTENTION MINORITY / WOMAN OWNED BUSINESS
The City of Salisbury, in a concerted effort with other local, state and federal agencies, actively seeks to identify minority businesses and offer them an equal opportunity to participate as providers of goods and services to the City. A minority business is defined as a business which, at minimum, is 51% owned and controlled by ethnic minority group members and/or women.

Are you a minority or woman owned business? *

Yes No

All minority owned businesses are requested to complete the following in the manner that bests describes their business. Please check all that apply:

African American Native American Hispanic American Asian American Woman Owned

I CERTIFY THAT THE INFORMATION PROVIDED HERE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE: *

Enter Name and Title Clear

A WORD TO POTENTIAL VENDORS - The City of Salisbury requires all purchases of $1000 or more to be authorized through the issuance of a City of Salisbury Purchase Order. Purchases less than $1000 (including freight and tax) may be charged by authorized City of Salisbury employees using our Purchasing Card. It is a vendor's responsibility to verify that individuals identifying themselves as City employees are employess in good standing. A single account should be established for the City - individual accounts by Department or Division are not recommended. Vendors who do not accept charge cards should invoice the City's Accounting Division at PO Box 479, Salisbury, NC 28145 or financeAP@salisburync.gov. The City is NOT exempt from paying sales and use taxes. Our Federal Taxpayer ID No. is 56-6000237. We are exempt from Federal Excise Tax. All prices should be quoted FOB Destination Prepaid Salisbury, NC.

Identify the commodities and services you can provide: *