Vendor Registration

How to Register as a Vendor

Please fill out the form below. Please direct any questions concerning vendor registration to Aaron Harris at 252-972-1236.



Purchasing Vendor Information Form
Company Information

New Vendor Existing Vendor (updating business information)

Business Name (as shown on your tax return)
Doing Business As (if different than above)
Order Address (street, city, zip, state)
Remit Address (if different than above)
Contact Name
Phone
Email
Ownership Status
Please complete the following ownership status (must be completed before a vendor can be set up).
Historically Underutilized Business
Minority Women Business Enterprise (MWBE)

  • If MBE, please choose:

    • African American

    • American Indian

    • Asian American

    • Latino

  • If WBE, please choose:

    • Women Business Enterprise

  • If DBE, please choose:

    • Disabled Business

    • Disadvantaged Business

Not Applicable
Certifying Agency
Please check the certifying agency (please send a copy of current certification letter, if applicable).
NC Office for Historically Underutilized Business (HUB Office)
NC Department of Transportation (NCDOT)
Self-certified (no current 3rd party certification)
Interested in 3rd party certification with the NC HUB Office
Interested in 3rd party certification with the NCDOT
Not Applicable
Products and/or Services
Please enter any products/services with which you would like your company to be identified.
If you are currently working with a city department to provide quotes for goods/services, please note the department/division name below.
Conflict of Interest
Do you have any relatives, or have a working relationship with anyone currently employed with the City of Rocky Mount?
Yes
If you answered "yes" to the previous question, please provide their name and relationship to you. Answering "yes" to the conflict of interest question will not automatically withdraw you from the vendor registration process.

I hereby certify that the information provided herein is correct:


Name & title


Date



Security Measure