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Fairfax County Supplier Update Form

IMPORTANT: This form is to update information for vendors who are currently registered in the Vendor Internet Portal. If you are a vendor who has provided goods and services or responded to solictiations to provided goods or services to Fairfax County within the past two years and wishes to receive an invitation to the Vendor Internet Portal, please fill out and submit the form located here.

New vendors, who have not provided or responded to solicitations to provide goods or services to Fairfax County in the past two years, must register using the Vendor Registration Form.

To update billing information contacts, please use the Finance Customer Billing Validation Form.

*Required Fields

Vendor General Information

*Vendor Name:

Doing Business as:

*Tax/EIN Number (TIN/EIN) (Numbers only, no dashes):         DUNS Number (Numbers only, no dashes):

Address (will be used as the corporate address, must match W-9)

Also use for (check all that apply):   Invoice Address            Purchase Order Address

*Street Address (including Apt/Suite):

*City:   *State:   *ZIP+4 Code:   *Country:  Please Select One United States Canada Other   Other:

P.O. Box:      P.O. ZIP+4 Code:

Communication

*Company Telephone:       Company Fax:

*Company Email:    Standard Method of Communication:  Please Select One EMAIL FAX MAIL PHONE

Contact Person

*Vendor Contact Name :

*Contact Phone:             *Contact Email:

Business Classification (More information)

*Business Classification Code:  Please Select One X00 = Classification Unknown G00 = Government Agency/Public Entity S00 = Small S01 = Small-Minority S02 = Small-Woman S03 = Small-Service Disabled S04 = Small-Minority - Woman S05 = Small-Minority-Woman-Service Disabled S06 = Small-Woman-Service Disabled S07 = Small-Minority-Service Disabled L00 = Large L01 = Large-Minority L02 = Large-Woman L03 = Large-Service Disabled L04 = Large-Minority-Woman L05 = Large-Minority-Woman-Service Disabled L06 = Large-Woman-Service Disabled L07 = Large-Minority-Service Disabled N00 = Non Profit N01 = Non Profit-Minority N02 = Non Profit-Woman N03 = Non Profit-Service Disabled N04 = Non Profit-Minority-Woman N05 = Non Profit-Minority-Woman-Service Disabled N06 =Non Profit-Woman-Service Disabled N07 = Non Profit-Minority-Service Disabled W00 = Sheltered Workshop W01 = Sheltered Workshop-Minority W02 = Sheltered Workshop-Woman W03 = Sheltered Workshop-Service Disabled W04 = Sheltered Workshop-Minority-Woman W05 = Sheltered Workshop-Minority-Woman-Service Disabled W06 = Sheltered Workshop-Woman-Service Disabled W07 = Sheltered Workshop-Minority-Service Disabled  Certified by:  Please Select One DMBE VMSDC WBENC Other   Other:

Certification Number:               Expiration Date:

Alternate Address Information (different than W-9)

Use for:   Invoice Address            Purchase Order Address

Street Address (including Apt/Suite):

City:   State:   ZIP+4 Code:  Country:  Please Select One United States Canada Other   Other:

P.O. Box:                    P.O. ZIP+4 Code:

Contact Person:      Telephone:

Fax Number:             Email Address:

Alternate Address Information (different than W-9)

Use for:    Invoice Address            Purchase Order Address

Street Address (including Apt/Suite):

City:   State:   ZIP+4 Code:  Country:  Please Select One United States Canada Other   Other:

P.O. Box:                    P.O. ZIP+4 Code:

Contact Person:      Telephone:

Fax Number:             Email Address:

Attachment and Submission Statement

Attachment: (Please attach your W-9)  NOTE: The filename you attach can only contain alphanumeric characters (no special characters such as ',_ *). The file size cannot be more than 3 megabytes.

CERTIFICATION: By submitting information through this form, you certify that: (i) you are authorized to submit the information for, or on behalf of, the person or entity identified; and, (ii) all of the information submitted is true and correct to the best of your knowledge, information, and belief. Any false statements made by you are subject to the penalties of law.

*Submitted By:    Submitter Email:

Comments: