City of Somerville, Vendor Registration Form
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Company Name (Legal Name, As Listed on W9) *
Please list the full legal name of your organization.
Contact Name *
Please list the first and last name of the point of contact at your organization.
Email Address of Point of Contact *
Please list the full email address of your point of contact.
Company Telephone Number *
Please list the full, 10-digit telephone number for your organization.
Street Address *
Please provide the company's full street address.
City *
State *
Zip Code *
Kind of Good or Service That Your Company Provides *
If more than one apply, please select one from each of the following sections.
Other, Good or Service Type
Please select "None Apply, Fill In “Other” Below", and write in below.
Kind of Good or Service That Your Company Provides  (2nd, If Applicable)
If more than one apply, please select one from each of the following sections.
Kind of Good or Service That Your Company Provides  (3rd Selection, If Applicable)
If more than one apply, please select one from each of the following sections.
Kind of Good or Service That Your Company Provides  (4th Selection, If Applicable)
If more than one apply, please select one from each of the following sections.
Kind of Good or Service That Your Company Provides  (5th Selection, If Applicable)
If more than one apply, please select one from each of the following sections.
Kind of Good or Service That Your Company Provides  (6th Selection, If Applicable)
If more than one apply, please select one from each of the following sections.
Kind of Good or Service That Your Company Provides  (7th Selection, If Applicable)
If more than one apply, please select one from each of the following sections.
Is your business owned and controlled by individuals that fall into the Supplier Diversity Program's certification designations?
Please select all that apply. Certificates may be required.
State Contracts
Please list any state contracts the City can use for your goods or services
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