vendor

Bidders Application Form

Please respond to all applicable questions and verify your information carefully prior to submitting.

Organization Type (Check All That Apply)

Public Agency

Minority Business

Small Business

Woman Owned Business

Company Name *

Contact Information for Orders/Services:

Street Address *

City *

State *

Zip Code *

Phone Number *

Contact Person (First Name, Last Name) *

Fax Number

Email Address *

Address Where Payment Should Be Sent (IF DIFFERENT from the address for orders/services)

Street Address

City

State

Zip Code

Phone Number

Contact Person (First Name, Last Name)

Fax Number

Email Address

Primary Contact

Contact Person (First Name, Last Name) *

Title *

Office/Branch *

Phone Number *

Fax Number *

Email Address *

Parent Company Information (If Applicable)

Company Name

Street Address

City

State

Zip Code

Phone Number

Fax Number

Email Address

Tax ID Number

Website Address

Upload W9

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Discount Availability Do you offer any discounts (for example, prompt payment discounts)?

Check One

Yes

If yes, please specify your requirements for discounts below. For example: • 2% if paid by 10th • Noted on invoice • Net 10 days from statement • Discount only when noted

By submitting this form I certify that the information supplied herein is correct. I understand that this form is subject to review and investigation prior to validation for procurement on approved vendor’s lists.

Name of Vendor *

Vendor Representative's Name *

Date *

Year

Month

Day

By selecting the box I certify that I am at least 13 years of age. *

Yes

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Information for Vendors

Please Direct Inquiries Concerning Procurement Processes To:

Phone: 703-335-8925
Email: SAprocurement@pwcsa.org

Mailing Address:

Prince William County Service Authority
Attn: Procurement Manager
P.O. BOX 2266
Woodbridge, VA 22195-2266

Vendor Meetings

Generally, Vendor Meetings are scheduled virtually through (MS Teams) as follows:

3rd Wednesday of the Month
10:00 a.m. - 12:00 p.m.
via MS Teams

Emergency Dispatch: (703) 335-7990

Customer Service: (703) 335-7950

vendor

Bidders Application Form

Information for Vendors

Please Direct Inquiries Concerning Procurement Processes To:

Mailing Address:

Vendor Meetings

Emergency Dispatch: (703) 335-7990

Customer Service: (703) 335-7950

Emergency Dispatch: (703) 335-7990

Customer Service: (703) 335-7950

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vendor

Bidders Application Form

Information for Vendors

Please Direct Inquiries Concerning Procurement Processes To:

Mailing Address:

Vendor Meetings

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Emergency Dispatch: (703) 335-7990

Customer Service: (703) 335-7950