Erie County
Water Authority

                                        295 Main St. * Room 350 * Buffalo, NY 14203-2494 * 716-849-8444 * Fax 716-849-8467

Vendor List Application

Please enter all of the information on the following form, and click submit
Name and Mailing Address for Bid Requests and Purchase Orders

Name:
Address:
City: State: Zip Code:
Country:
Contact Person:

Products or Services Offered

 

Name and Mailing Address for Payments

Name:
Address:
City: State: Zip Code:
Country:
Contact Person:

Business Information

Phone Number:  Fax Number:
Web Site:
E-Mail Address:
Place of Business:
Type Of Business:
Federal ID # (EIN): or Social Security #:

Are Vendor Payments Reportable?

Vendor Payments ARE Reportable to the IRS on Form 1099-Misc.:
Yes No

Minority Business

Certified Minority Business Classified as:
Recieved Minority Certification From:

Submit Form
By clicking SUBMIT I Hereby Certify That The Information Supplied Herein is Correct.








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