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Local Vendor Registration Form
Leave This Blank:
Company Name
*
Sales Contact Person
*
Principal Place of Business Address
*
Sales Office Mailing Address
*
Sales Phone Number (w/o the dashes)
*
Sales Fax Number
Sales Email Address
*
Company Website
Is your company registered with the Texas Comptroller’s Office as a Historically
Underutilized Business?
*
Yes
No
Has your company been awarded a contract through one or more of the following
cooperative purchasing programs?
(Buyboard, US Communities, TCPN, TXMAS, HGAC, National IPA)
*
Yes
No
Name of Cooperative Purchasing Program
Commodity Contracts Awarded
Descripton of Service/Product
*
Authorized Signature
*
Date
*
* indicates required fields.
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