Vendor Registration Form

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If you would like your company to be registered with Appomattox County for the purpose of participating in the County's solicitation process, please complete and submit the form below.  Please note that all items with a red asterisk are required.  You may also download a Form W-9 from the IRS and email it to john.spencer@appomattoxcountyva.gov when completed.

Download Form W-9 (Rev. December 2011) - Internal Revenue Service

Please correct the field(s) marked in red below:

1
Business Name:
 *
2
Tax ID Number:
 *
3
Address Line 1:
 *
4
Address Line 2:
5
City:
 *
6
State:
 *
7
Zip Code:
 *
8
Telephone Number:
 *
9
Contact Name:
 *
10
Title:
 *
11
Email Address:
 *
12
Commodities or Services Offered:
 *
13
Virginia governments to which you have sold in the past two (2) years:
 *
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