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Application Date: |
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Federal
Identification
#: |
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Company Name:
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Street Address: |
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City: |
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State: |
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Zip: |
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Phone: |
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Fax: |
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Type of
Organization:
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How long in present business? Years
Months
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State General
Contractor’s License Number:
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City of
Greensboro Privilege License Number:
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Contact Person: |
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Contact Title: |
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Contact Phone: |
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Contact E-Mail |
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Would you like to be contacted via email when new bid opportunities arise?
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Interested in work of: |
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Type of Business or Service
(List all areas of work in which you would like to bid):
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Bank References |
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Name |
Address |
Telephone |
Contact |
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Trade References |
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Name |
Address |
Telephone |
Contact |
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Interest Group Definition (Please indicate if any of
the following apply) |
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Minority Owned
1:
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If yes, please indicate specific group:
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(Other
Minority): |
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Female Owned
1: |
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Physically Handicapped
1 |
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Small Business
2 |
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1 At least 51% owned and controlled by a minority group, female, or physically challenged individual. |
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2 Less than 100 employees and yearly sales grossing not more than $500,000 |
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A valid, original Certificate of Insurance is also required.
Please mail Certificate to: |
Purchasing Dept., PO Box 21287, 450 North Church St., Greensboro, NC 27420 |
