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Vendor Registration Form

  2. Registering with the city helps connect you and city staff, improving opportunities for us to do business together. Please complete and submit the form below, so that we can add you to our records.

  4. Please enter your parent company's name.

  6. If your company uses a trading-as name, please enter it here.

  12. Please enter additional information pertaining to your company's billing address (e.g. ATTN: Billing Department).

  24. Please enter additional information pertaining to your company's mailing address (e.g. ATTN: General Information).

  41. Please enter the full URL for your company's website, including the http:// prefix (e.g., http://www.mycompany.com).

  43. Please select the type that best describes your company's organization.

  44. Product Type*

    Please select the type of product that your company sells.

  48. Small, Women, and Minority-Owned (SWaM) Designation

    Please indicate if your firm is a Small, Woman-owned or Minority-owned business. You may select more than one designation, if applicable. Please refer to the Commonwealth of Virginia Small Business Supplier Diversity website (SBSD) for designations and enter the certification number below. If your firm has a SWAM certification from another State, local government entity or other agency (i.e. National Minority Supplier Development Council) or Disadvantaged Business Enterprise Certification (DBE), please provide the name of the certifying entity/agency and the related certification number and attach evidence of certification where indicated. Note: Certification criteria from another entity or agency must be similar to the SBSD program. Self-certification programs are not acceptable.

  50. Service Disabled Veteran Business

    Veterans wishing to apply for service disabled veteran status must first seek eligibility certification from the Department of Veteran Services by calling 540-857-7101 or visiting the DVS website. Please indicate if your business is certified as a Service Disabled Veteran Business.

  62. Equipment, Supplies, or Services Provided

    Please identify equipment, supplies, materials, and/or services on which you wish to bid.

  66. W-9 Submittal

    Please provide your current Department of Treasury Form W-9 (Rev. December 2014). Failure to provide the current revision will delay processing of your vendor registration. All registered vendors are required to have a current W-9 on file.

    75. Leave This Blank:

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