3. 

6. City of Lawrenceville Vendor Registration Form 

   A completed and signed IRS W-9 form and the completed registration form must be submitted. 

8. Business Name*
10. Contact Name (Name of Business Contact) *
12. Phone Number*
13. Fax Number
15. Email Address for Contact Person*
16. Email for Purchase Orders
18. Corporate Address*
20. City*
21. State*
22. Zip Code*
24. Is your Remittance Address the same as your Corporate Address?*

    1. Yes
    2. No
26. Remittance Address
28. City
29. State
30. Zip Code
32. Primary Goods/ Services your Company is interested in providing: *
34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
36. Electronic Signature*
37. Printed Name*
39. Date*
40. Title*
42. Completed and Signed IRS W-9 Form*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field