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4. Application Type*

   1. New Application
   2. Revised Application
6. Name of Supplier/Individual*
7. Applicant Type*

   1. Company
   2. Individual
9. FEI/SSN/TIN NUMBER*
10. Occupational Tax County of Registration*
12. Company Remittance Address*
    Douglas County will use this address to make payments for goods and services.
14. Firm Organized As:*

    1. Individual
    2. Partnership
    3. Joint Venture
    4. Sole Proprietorship
    5. Corporation
    6. Non-Profit

    1. Large Business (>$1,000,000 in annual sales)
    2. Small Business (< $1,000,000 in annual sales)
    3. DBE
    4. MBE
    5. Woman Owned Business
    6. Veteran Owned Business

    Check all that apply.

    Based on Georgia Law (OCGA 50-5-21) (3) “Small Business” means any business which is independently owned and operated. Additionally, such business must either have 300 or less employees or $30 million or less in gross receipts per year. 

    
    

18. Contact Information
20. Contact Person*
21. Contact Person Phone No.*
22. Contact Person Fax No.
24. Company Mailing Address
    (if different from remittance)
25. City, State, and Zip Code*
27. Contact Email Address:*
29. Email address for Purchase Orders*
31. Principal Line of Business*

    (subject areas you wish to be considered as a vendor)

32. Commodity Codes related to your business:*
    Please list all that apply. For Commodity Code listing see website.
36. Are you a Douglas County Employee?*

    1. Yes
    2. No
37. Do you have relatives employed by Douglas County?*

    1. Yes
    2. No
39. If yes, name, department and how are you related?*
43. TYPE OF ACTIONS*

    1. DEACTIVATE Supplier Profile (enter justification below)
    2. REACTIVATE Supplier Profile
    3. Supplier (Business ) Name Change
    4. Update Business Information
    5. Other
    6. Not Applicable

    (Required for revised applications only)

45. ADDITIONAL SUPPLIER COMMENTS

    (Required if "Other" or "Deactivate" boxes are checked above)

49. Required Document Upload
    You must upload each document in PDF/DOC/DOCX format in order to submit the Vendor Application.
51. Required Documents
    Download Vender Application Documents

    Download the Vendor Packet and fill out the W-9 Form, Subcontractor and Contractor Work Authorization Affidavits, and the County Public Benefit Application Affidavit. Scan and upload the completed forms below.

53. Completed W-9 Taxpayer Form*
54. Completed Contractor and Subcontractor Affidavits*
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field