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Vendor Registration Form

2. Business Type*

   1. Government Entity
   2. Incorporated

   1. LLC
   2. Partnership

   1. Sole Proprietorship
   2. Other

4. Name on Internal Revenue Service (IRS) Record*

6. Phone Number*

7. Fax Number

9. Company DBA Name*

   Payments will be made payable to this name.

11. Phone Number*

12. Fax Number

14. W9 or 1099 Address*

    P.O. Box, Street, Apartment, Suite, City, State

15. 9 Digit Zip*

17. Website

19. Federal Tax Identification Number*

23. Type of Payee*

    1. Consultant
    2. Contractor
    3. Legal

    1. Medical Services
    2. Other

25. Describe other:

29. Purchase Order Information
    (If different than already listed)

    (If different than already listed)

31. Name/Title

33. Address

35. Phone

36. Fax

37. Email Address

41. Bid/Quote/Proposal Information
    (If different than already listed)

    (If different than already listed)

43. Name/Title

45. Address

47. Phone

48. Fax

49. Email

53. Remit to Information
    (If different than already listed)

    (If different than already listed)

55. Name/Title

57. Address

59. Phone

60. Fax

61. Email

65. Sales Tax*

    Haywood County is required to pay North Carolina state and local sales tax. Please state whether you are set up to charge these taxes on your invoices.

    1. Yes
    2. No
67. Invoice Payment Terms
    Haywood County payment terms are net 30 days from the date of receipt of invoice, unless any available discounts are indicated on the invoice.

    Haywood County payment terms are net 30 days from the date of receipt of invoice, unless any available discounts are indicated on the invoice.

69. Purchase Orders
    Purchases of $1,000 or above require a purchase order number.

    Purchases of $1,000 or above require a purchase order number.

71. Required Forms
    An IRS W-9 form is required before payment will be made to any vendor.

    An IRS W-9 form is required before payment will be made to any vendor.

75. Do you have Workers' Compensation Insurance?*

    1. Yes
    2. No

    (Proof of Workers' Compensation Insurance may be requested)

76. Do you have Liability Insurance coverage?*

    1. Yes
    2. No

    (Proof of Liability Insurance may be requested)

78. Contractor's license number, if applicable

80. Does your business deliver to/service Waynesville, NC?*

    1. Yes
    2. No

82. Is there a delivery charge for this?*

    1. Yes
    2. No

86. Minority & Women Business Enterprise (MWBE) Vendor/Supplier Information
    To qualify for MWBE vendor status, 51% of the company must be owned and controlled by a minority or a woman (single or group).

    To qualify for MWBE vendor status, 51% of the company must be owned and controlled by a minority or a woman (single or group).

88. Owner

89. President

91. Indicate if you are certified as an MWBE Vendor by:

    1. State of North Carolina
    2. Other

93. Please check the following that apply:

    1. African American
    2. American Indian
    3. Asian

    1. Economically Disadvantaged
    2. Hispanic
    3. Woman

97. Commodities

    Please use the space to describe the commodities you sell or the services you wish to provide to Haywood County, or attach line cards or other information to this form.

99. Attach Supporting Documents

Leave This Blank:


101. 1. Receive an email copy of this form.
102. Email address

     This field is not part of the form submission.

103. Submit

* indicates a required field