Vendor Registration Form - Brazos Transit District

Company Name *

Address *

Street Address City State ZIP Code

Federal Tax ID or Social Security # *

0 of 15 max characters

Annual Gross Receipts of Company *

Year Established *

0 of 4 max characters

Number of Employees *

Website *

Contact Person *

Title *

Phone *

Fax

Email *

Company Ownership *

Sole Proprietorship
Partnership
Corporation

Are you a Historically Underutilized Business (HUB)? *

Yes
No

(Learn more about HUB)

HUB # *

Are you a Disadvantaged Business Enterprise (DBE)? *

Yes
No

(Learn more about DBE)

DBE # *

List the equipment, supplies, materials and/or services you would like to be on the Vendor/Bid List for: *

Check the area(s) you are interested in providing services in: *

Bryan
Livingston
Lufkin
Nacogdoches
The Woodlands

List three references that you have recently provided goods/services for:

Reference 1

Company Name *

Contact Name *

Phone *

Address *

Street Address City State ZIP Code

Reference 2

Company Name *

Contact Name *

Phone *

Address *

Street Address City State ZIP Code

Reference 3

Company Name *

Contact Name *

Phone *

Address *

Street Address City State ZIP Code

Comments

This field is for validation purposes and should be left unchanged.