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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)
31. Name/Title
33. Address
35. Phone
36. Fax
37. Email Address
41. Bid/Quote/Proposal Information
    (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)
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.
69. Purchase Orders

    Purchases of $5,000 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.
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).
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