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PURCHASING VENDOR ENROLLMENT FORM 2019-10-15

  1. County of Humboldt - The Home of the Redwoods Seal


  2. COUNTY OF HUMBOLDT

    County Administrative Office
    Purchasing & Disposition Team
    825 5th St, Rm 112, Eureka CA 95501
    Ph: 707-268-2544 Fax: 707-445-7299
    purchasing@co.humboldt.ca.us

  3. VENDOR ENROLLMENT FORM

  4. VENDOR INFORMATION

  5. (Must Match W9)

  6. Vendor Type

    (check all that apply)

  7. California Vendors:

  8. SALES CONTACT INFORMATION

  9. Do you accept purchase orders?

  10. Via Email?

  11. Does the County of Humboldt currently have an account with your company?

    If Yes, please list all account numbers

  12. BILLING CONTACT INFORMATION

  13. Can you email invoices?

    Yes is preferred

  14. County Bill-To Address

    Submit invoices to contact address on purchase order(s) or in accordance with contract terms.

  15. RESPONDENT

  16. You are required to submit a W-9 with this form. Is your W-9 attached?

    Must be in .pdf, .png or .jpeg format.

  17. Sole Proprietor?*

    ***If "Yes" is checked - BOTH a TIN and SSN are required on your W-9 by the state of CA***

  18. PAYMENT INFORMATION

  19. Negotiable discount based on business volume?

  20. Accept payment by check or EFT?

  21. Do you accept credit card payments?

  22. Discounts if paid with credit card?


  23. One of the following uploads is required to sign up for EFT payments.



  24.            OR

  25. Must include:
    *Verification of account ownership
    *Bank routing number
    *Bank account number

  26. For inquiries, please contact us at (707) 268-2544 at Purchasing@co.humboldt.ca.us.

  27. Leave This Blank:

  28. This field is not part of the form submission.