2. Department or Individual Submitting Request
4. Company
6. Company Address
8. City
9. State
10. Zip Code
12. Phone Number
13. Fax Number
15. Contact Person
16. Email Address
18. Federal Tax ID Number (Business)
20. Contractor License Number (if applicable)
22. Type of Organization

    1. Corporation
    2. Individual
    3. Partnership
    4. Other
23. If the type of organization is other, please explain.
27. Officers, Owners, or Partners
29. President
30. Vice President
32. Secretary
33. Treasurer
34. Owners/Partners
36. Type of Business

    1. Manufacturer
    2. Construction
    3. Registered Dealer
    4. Surplus Dealer

    1. Service Establishment
    2. Architect/Engineer
    3. Other
37. If the type of business is other, please explain.
39. Products and/or Services Offered (additional information may be attached)
40. Additional Resources
42. Indicate types of requests your company would like to be informed of (check all that apply)

    1. Low-value purchases (less than $500)
    2. Informal bids (less than $30,000)
    3. Formal bids ($30,000 and above)
    4. Construction projects
    5. Requests for proposals
43. Please upload a copy of your IRS Form W-9
45. If Printing and Returning by Mail:

    Please return this form and IRS Form W-9 to:
    
    Rowan County Human Resources
    Attn: Purchasing Department
    130 W Innes Street
    Salisbury, NC 28144

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field