2. City of Farmington
   Central Purchasing Division 805 Municipal Drive Farmington, New Mexico 87401 Phone: 505-599-1373 Hours: Monday-Friday 8:00 a.m.-5:00 p.m. MT
4. Is this a new vendor registration or a vendor information update?*
   -- Select One --New RegistrationVendor Information Update

   Please choose new registration or vendor information update from the drop-down menu.
6. Vendor's Name:*
7. Telephone Numbers:*
9. Address (including City, State and Zip Code) to which Bid requests and confirming Purchase Orders are to be mailed:*
10. Contact Name for Bid Requests and Purchase Orders:*
11. Email for Bid Requests and Purchase Orders:*
13. Address (including City, State and Zip Code) to which payments are to be mailed:*
14. Contact Name for Accounting Department:*
15. Email Address for Accounting Department:*
17. Are you Incorporated:*

    1. Yes
    2. No
18. If Yes, what state? (abbreviate)
20. In-State/Veteran Preference Certification
    Click Here

    You may qualify for In-State/Veteran Preference which could assist you in the bidding process. To see if you qualify or to register, please visit the New Mexico Taxation and Revenue website by clicking on the link above.
22. Commodity/List Book
    Click Here
23. Commodities/Sub-Commodities *
    List products/services you can furnish by choosing them from the Commodity/List Book. List the commodity separated by a hyphen, then the sub-commodity and separate each entry with a comma. Example: 255-255, 255-125, 310-410. If you are unsure of how to complete this section, please contact 505-599-1373.
24. Please list commodities not found:
26. Are you working directly with a city employee?
    If yes, please provide their name and contact information (department, phone number, email address, etc.)
28. Does your company offer a prompt payment discount?*
    Please indicate "no" in this box if your company does not offer the discount. If your company does offer the discount, please indicate the "Discount Percentage: and the "Discount Days". (Example: 10%, 10 days)
30. Authorizing Person - Name and Title*
    Certification: I hereby certify that all statements made in this application are true and complete to the best of my knowledge and I understand that misrepresentation of material facts will cause forfeiture of my rights to bid with the City Central Purchasing Office.
31. Date*
33. W-9 Form REQUIRED for registration processing
    Click here to download blank W-9

    This form may be submitted via * email to accountspayable@fmtn.org * fax to 505-599-1553 * mail to 800 Municipal Drive, Farmington, NM 87401, Attn: Accounts Payable * hand delivered to 805 Municipal Drive, Farmington, NM 87401
35. ACH Authorization Form
    ACH Authorization Form

    This form may be submitted via * email to accountspayable@fmtn.org * fax to 505-599-1553 * mail to 800 Municipal Drive, Farmington, NM 87401, Attn: Accounts Payable * hand delivered to 805 Municipal Drive, Farmington, NM 87401
37. Disclaimer
    The City of Farmington is not responsible for any lost or stolen sensitive information sent via unsecured transmission.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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