Vendor Registration

Please provide the following information and we will sign you up for inclusion on our City of Brownsville Master Vendor List.

Questions??? Call Roberto C. Luna, Jr., Purchasing Director at 956-548-6081 or e-mail: roberto@cob.us Thank you!

Name of person filling out the form:

* First Name

* Last Name

* Is this a New Registration?

Yes

* Updated Registration?

Yes

* Today's Date:

* Legal Name of Business:

* Owner's Name:

* Business Contact Person:

* Title

* Work Phone:

* Fax:

* Mailing Address:

* Physical Address:

Address 2:

* City:

* State:

* Zip:

* Country:

* Email Address

Web Site:

* Federal ID / Social Security No.:

* Home Based Business:

Yes

* How long in present business (# years)?

Complete this Section if Applicable:

Parent Company

Division

Subsidiary

Headquarters Location

* Indicates Response Required