Charlotte County Purchasing Vendor Application
Instructions: This electronic application is the first step for placement on Charlotte County's Vendors listing system.
Please read carefully and complete all items.
Tips on doing business with Charlotte County
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R		 Date 11/7/2009 3:12:41 PM
Name of Firm/DBA
Individual Name
Principal Contact
The above name is authorized to sign bids, contracts, and checks  
If no, please indicate who is an authorized representative. 
Mailing Address
Address
City State/Province 
Zip      Country   
Business Phone Fax Number
Cell Phone E-Mail
 
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Remittance Address (if different than above)
Remittance Name
Remittance Address
City State/Province
Zip            Country 
 
L
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E		 Business is licensed (unless exempt by applicable law), permitted or certified to do business in the State of Florida:  
License #
Charlotte County Occupational Lic #
State of Florida Corporation ID#
State of Florida Fictitious Name Reg#
 
I
D		 Type of Organization  
Is your business a Disadvantaged Business Enterprise (DBE)? 
Social Security # or xxx-xx-xxxx
Federal Tax ID # xx-xxxxxxx
 
S
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I hereby certify that the information supplied herein is correct:  (This is a legal signature, please insure all informaton is accurate.)
 
 
Name Title
E-Mail
 
 

     
You must now submit your information and
choose your Commodity/Service Codes in Step Two