NVR (Rev. 06/10)

New Vendor Registration

Monroe County Purchasing DepartmentPrint Form

200 County Office Building

39 West Main Street

Submit by Email

Rochester, NY 14614

Phone (no spaces):Cell Number (no spaces):

PURCHASE ORDER ADDRESS INFORMATION:

Number & Street:

Street 2:

City/Town:State:Zip:Country:

Email:Fax:

VENDOR TAX INFORMATION (Either SSN or Federal Employer ID Number):

SSN:ORFEIN #:

MINORITY AND WOMEN'S BUSINESS ENTERPRISE INDICATOR:

Are you a minority- or woman-owned business?

Veteran-Owned Business

Service Disabled Veteran-Owned Small Business (SDVOSB)

PURCHASING DATA:

Shipping Terms:(e.g., FOB Destination)

Salesperson:

Phone Number:

Vendor's Account Number:

INDICATE MATERIAL GROUP(S) ON PAGE TWO.

Please email (mcpurchasing@monroecounty.gov) or print and fax

NVR (Rev. 06/10)

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New Vendors must review the Material Groups listing (//www.monroecounty.gov/purchasing/materials) on

the left navigation menu and identify the number and name of the material group(s) their company is able to

provide in the areas below. Upon completion and submission, you will receive an e-mail notification that your

company information was recorded. You must enter at least one material group code and description.