GLADSTONE PUBLIC SAFETY
CITY OF GLADSTONE

NEW VENDOR APPLICATION FORM
Email Address:

Legal Name:
(Must match name on Tax ID number  
   
Make checks payable to:
   
Are you a:

Other:
   
Federal Tax ID # or Social Security #:
   
Remittance Address:
   
Order Address:
(If different)
   
Bid Address:
(If Different)
   
Phone Number:
Fax Number for Bids:
Fax Number for Accounting:
   
Contact Name:
   
Purchase Terms  
     Discount Amount
     Discount Days:
     Net Due In:
   

Please describe your business, or tell us what we'll be buying from you.

This is important in determining if you will receive a Form 1099