City of Peoria Grant Awardee New Vendor Form Submission (TIG)

City of Peoria Grant Awardee New Vendor Form Submission
This page serves as a submission tool to submit a copy of your business's W-9 and complete a New Vendor Request Form.

You will need a copy of your W-9 ready to upload at the end of this form.
IRS W-9 Form Name:*
Name as appears on W-9
DBA (Doing Business As):
Leave blank if not applicable
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact Name*

First NameLast Name
Primary Contact Job Title*
Primary Contact Phone Number*
Please enter a valid phone number.
Primary Contact Email*
example@example.com
Accounting Contact Name

First NameLast Name
Accounting Contact Phone Number
Please enter a valid phone number.
Accounting Contact Email
example@example.com

Services to be provided to the City of Peoria
Are you a Minority Owned or Woman Owned Business?*

YesNo
Please visit https://www.peoriagov.org/249/Equal-Opportunity-Office for information on how to become a PeAP vendor.
Supplier Diversity Certification*

MBEWBEDBENot Applicable
If your company is a certified MBE, DBE, or WBE vendor, please select the appropriate box and attach the current certification.
MBE/WBE/DBE certification

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Upload W-9*

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By signing, I acknowledge that the information here is true and correct.*

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