2. Date
   Date
4. Vendor Name
6. Street Address1
8. Address2
10. City
11. State
12. Zip
14. Post Office Box
16. City
17. State
19. Zip Code
20. County
22. Phone
23. Email Address
25. Upload a copy of your company W9*

    Select file to upload

26. Website Address

28. To qualify for W/MBE status, 51% of the company must be owned, operated and controlled by an individual or a group that is disabled, a minority, or female.

29. Are you a minority business?

    1. Yes
    2. No
30. Do you accept credit cards?

    1. Yes
    2. No
32. Contact Name
33. Phone
35. Toll Free Number
36. Contractor's License
38. List types of products and or services that your company provide
40. This form was filled out by?
    Name
41. Title
43. Lincolnton Finance Department
    P.O. Drawer 617
    Lincolnton NC, 28093
    
    Phone: 704-736-8980
    
    Fax: 704-736-8999
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46. Email address

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