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Vendor Information Form

  1. Please complete this form and return it to:

    Purchasing Agent, City Hall Room 105
    100 Broadway, Norwich, CT 06360-4431
    Phone: (860) 823-3706 Fax: (860) 823-3812

  2. If you are an individual or sole proprietor, the individual's name as the owner must appear as the Legal business name.

  3. Sales Contact Information

  4. Do you accept purchase orders by:

  5. Accounts Receivable Contact Information

    Please fill in this section if it differs from the Sales Contact Information

  6. All ACH/EFT payments will be to a checking account.

  7. All goods, materials, equipment, and or services purchased under a purchase order requires the vendor to accept payment of funds in electronic form.

  8. Leave This Blank:

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