This form is used by vendors ecpecting payment from the city for products or services rendered but are not actively seeking to be part of the bidding process. Name * As it should appear on payment DBA Name Remittance Address * City * State * Zip * Mailing Address * City * State * Zip * A/R Contact Email Address * Phone Number * Fax Number Sales Representative Email Address * Phone Number Tax ID or Social Security # * Please do not include spaces or special characters (-,*,#) Discount if offered, terms Leave this field blank