Form Center

2. Company Name*
4. DBA Name
6. Remittance Address*
8. Address2
10. City*
11. State*
12. Zip*
14. A/R Contact*
15. Email Address*
17. Phone Number*
18. Fax Number
20. Sales Representative
21. Email Address
23. Phone Number
24. Fax Number
26. Tax ID Number*
27. Discount if offered, terms
29. Attach Completed W-9*
30. Blank W-9 Form
    W-9
32. Commodity Codes*
    -- Select One --005 ABRASIVES010 ACOUSTIC TILE, INSULATE MATERIAL020 AGRICULTURAL EQUIPMENT025 AIR COMPRESSORS & ACCESSORIES031 AIR CONDITIONING & HEATING325 ANIMAL SUPPLIES - FEED040 ANIMALS - LIVE045 APPLIANCES / REPAIR SERVICE906 ARCHITECT & OTHER DESIGN050 ART EQUIPMENT & SUPPLIES055 AUTO & TRUCK ACCESSORIES060 AUTO & TRUCK MAINTENANCE ITEMS070 AUTO MAJOR TRANSPORTATION075 "AUTO SHOP EQUIPMENT &928 AUTO MAINTENANCE & REPAIR929 AUTOMOTIVE TOOL REPAIR080 BADGES & OTHER ID EQUIPMENT085 BAGS, BAGGING, TIES, EROSION100 BARRELS, DRUMS, KEGS, CARTON101 BATTERIES105 BEARING (EXCEPT WHEEL)110 BELTS AND BELTING870 BLINDS, WINDOW COVERINGS120 BOATS, MOTORS & MARINE125 BOOKBINDING & BOOK SUPPLY135 BRICKS & CLAY PRODUCTS150 BUILDER'S SUPPLIES910 BUILDING MAINT. / REPAIR SERVICE155 BUILDING, FABRICATED165 CAFETERIA & KITCHEN EQUIPMENT175 CHEMICAL LAB EQUIP & SUPPLY190 CHEMICAL, COMMERCIAL, BULK061 CHEMICALS & OIL192 CLEANING195 CLOCKS200 CLOTHING & APPAREL915 COMMUNICATIONS, MEDIA205 COMPUTERS, DATA PROCESSING210 CONCRETE & METAL CULVERTS918 CONSULTING SERVICES220 CONTROL, RECORDING INSTRUMENTS225 COOLER-DRINKING WATER015 COPY MACHINE SUPPLIES232 CRAFTS - GENERAL850 LINENS530 LUGGAGE, BRIEFCASE, PURSE540 LUMBER & RELATED PRODUCTS550 MARKERS, PLAQUES, SIGNS568 MEDICAL EQUIPMENT & SUPPLIES575 MICROFICHE, MICROFILM931 MISCELLANEOUS EQUIPMENT REPAIR962 MISCELLANEOUS SERVICES578 NOVELTY PRODUCTS595 NURSERY STOCK & SUPPLIES600 OFFICE MACHINES & REPAIR615 OFFICE SUPPLIES - GENERAL625 OPTICAL EQUIPMENT ACCESS. & SUPPLY635 PAINTING EQUIPMENT & REPAIR630 PAINTS & WALLPAPER645 PAPER (OFFICE, PRINT SHOP)640 PAPER & PLASTIC - DISPOSABLE650 PARK/REC EQUIPMENT & REPAIR655 PHOTOGRAPHIC EQUIPMENT658 PIPE AND TUBING659 PIPE FITTINGS665 PLASTICS670 PLUMBING EQUIPMENT/SUPPLY675 POISONS: AGRICUL & INDUSTRY680 POLICE EQUIPMENT & SUPPLY651 POOL SUPPLY & EQUIPMENT700 PRINTING EQUIP & SUPPLIES966 PRINTING, TYPESET961 PROFESSIONAL SERVICES715 PUBLICATION - AUDIOVISUAL720 PUMPS & ACCESSORIES730 RADIO & TELE TEST EQUIPMENT725 RADIO & TELECOMMUNICATION735 RAGS, SHOP TOWELS740 REFRIGERATION EQUIPMENT975 RENTAL / LEASE EQUIPMENT745 ROAD / HIGHWAY MATERIALS760 ROAD / HIGHWAY EQUIPMENT770 ROOFING MATERIALS772 SAFETY EQUIPMENT & SUPPLIES998 SALE SURPLUS & OBSOLETE785 SCHOOL EQUIPMENT & SUPPLIES990 SECURITY, FIRE, SAFETY SERVICE233 CRAFTS - SPECIALIZED255 DECALS AND STAMPS265 DRAPES, CURTAINS, UPHOLSTERY270 DRUGS, PHARMACY280 ELECTRICAL CABLES & WIRE285 ELECTRICAL EQUIPMENT & SUPPLY287 ELECTRONIC COMPONENTS295 ELEVATORS- BUILDING TYPE300 EMBOSSING, ENGRAVING290 ENERGY COLLECTING EQUIPMENT059 ENGINE & TRANSMISSION305 ENGINEERING EQUIPMENT925 ENGINEERING SERVICES315 EPOXY BASED FORMULAS318 FARE COLLECTION EQUIPMENT & SUPPLY320 FASTENERS, FASTENING DEVICES330 FENCING335 FERTILIZERS & SOIL CONDITIONERS946 FINANCIAL SERVICES340 FIRE PROTECTION EQUIPMENT &345 FIRST AID & SAFETY EQUIPMENT350 FLAGS, POLES, BANNERS, ACCESSORIES056 FLEET AUTOMOTIVE360 FLOOR COVERING - INSTALLED365 FLOOR MAINTENANCE MACHINES, PARTS375 FOODS: ALL KINDS400 FOUNDRY CASTINGS, EQUIPMENT405 FUEL, OIL, GREASE, LUBES420 FURNITURE - NON OFFICE425 FURNITURE - OFFICE435 GENERAL CONSTRUCTION440 GLASS & GLAZING SUPPLIES988 GROUNDS MAINTENANCE445 HAND TOOLS - POWER & NON-POWER450 HARDWARE AND ACCESSORIES948 HEALTH RELATED SERVICES460 HOSES - ALL KINDS953 INSURANCE - ALL TYPES485 JANITORIAL SUPPLIES495 LAB & FIELD EQUIPMENT954 LAUNDRY & DRY CLEANING SERVICE515 LAWN EQUIPMENT & REPAIR525 LIBRARY MACHINES & SUPPLIES956 LIBRARY SERVICES867 SEWER UTILITY800 SHOES AND BOOTS801 SIGNS & SIGN MATERIAL803 SOUND SYSTEMS & ACCESSORY810 SOILS & MATERIALS805 SPORTING & ATHLETIC EQUIPMENT820 STEAM & HOT WATER BOILERS815 STEAM & HOT WATER FITTING830 TANKS: MOBILE, PORTABLE, STATION835 TEACHING, TRAIN MATERIALS840 TELEVISION EQUIPMENT & ACCESSORIES845 TESTING APP/NOT ELECTRIC860 TICKETS, COUPON BOOKS, ETC861 TRAFFIC CONTROL MATERIALS865 UTILITY SERVICE MATERIALS875 VET EQUIPMENT & SUPPLIES880 VISUAL EDUCATION EQUIPMENT890 WATER SEWAGE TREATMENT866 WATER UTILITY885 WATER & SEWER TREATING CHEMICALS895 WELDING SERVICE, EQUIPMENT &001 Not listed - Detail Below
34. Add Additional Commodity Codes Here
36. ACH Payment Request Form
    Form

    As of October 7, 2010 ACH payments were implemented to ensure invoices are paid in a timely manner which has resulted in physical checks being issued BI-WEEKLY only. To receive future payments by ACH, which are done weekly, please follow the Form link to sign up.
38. Have you signed up for ACH payments (above) as part of this vendor registration?*
    -- Select One --YESNO
40. For Disadvantaged Business Enterprises Only
    Disadvantaged Business Enterprises (DBE) are encouraged to participate in the City of North Richland Hills bid process. Representatives from DBE Companies should identify themselves as such and submit a copy of their Certification. The City of North Richland Hills recognizes the certifications of both the State of Texas Building and Procurement Commission HUB Program and the North Central Texas Regional Certification Agency.
42. Select all that apply

    1. Minority-Owned Business Enterprise

    1. Women-Owned Business Enterprise

    1. Disadvantaged Business Enterprise
44. Upload Certification
45. Upload Certification
46. Upload Certification
48. All companies seeking information concerning DBE certification are urged to contact:
50. Texas Building and Procurement Commission Statewide HUB Program
    website

    1711 San Jacinto Blvd., Austin, TX 78701-1416 * PO BOX 13186, Austin, TX 78711-3186 * (512) 463-5872
51. North Central Texas Regional Certification Agency
    website

    624 Six Flags Drive, Suite 216, Arlington, TX 76011 (817) 640-0606
Leave This Blank:


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56. Email address

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