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CITY OF DECATUR VENDOR APPLICATION

2. PLEASE TELL US WHAT DEPARTMENT OF THE CITY OF DECATUR YOU ARE DOING BUSINESS WITH.*
4. WHO IS THE DEPARMENT POINT OF CONTACT YOU ARE COMMUNICATING WITH?*
6. YOUR COMPANY NAME AND ADDRESS
8. NAME OF FIRM *
   (COMPANY OR INDIVIDUAL)
9. DBA NAME*
11. PHONE NUMBER*
12. FAX NUMBER
14. ADDRESS*
15. CITY*
17. STATE*
18. ZIP*
20. TYPE OF ORGANIZATION/GOODS/SERVICES*
22. POINT OF CONTACT*
23. CONTACT EMAIL ADDRESS*
24. COMPANY WEBSITE*
26. REMITTANCE ADDRESS*
28. DO YOU ACCEPT VISA*

    1. YES
    2. NO
30. W-9 INFORMATION*

    I understand that...

    1. The City of Decatur cannot assign a City Vendor Number without a copy of the vendor's signed IRS W-9 form on file with the City's Finance Department.
    2. This Vendor application shall be put "on hold," and a payment shall not be issued until a W-9 is received by the City of Decatur Finance Department.
32. You may upload your COMPLETED and SIGNED W-9 Form here.
    If you choose not to upload your W-9 Form here, you may email it to: APINVOICES@DECATURTX.ORG or mail it to: CITY OF DECATUR ACCOUNTS PAYABLE PO BOX 1299 DECATUR, TX 76234
33. If you would like payments to be sent to you via ACH, you may upload your COMPLETED and SIGNED ACH Authorization Form here.
    If you choose not to upload your ACH Authorization Form here, you may email it to: APINVOICES@DECATURTX.ORG or mail it to: CITY OF DECATUR ACCOUNTS PAYABLE PO BOX 1299 DECATUR, TX 76234
35. Signature
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
37. I agree to the above statement and confirm that all the information on this application is true and accurate to the best of my knowledge.*

    1. I AGREE
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field