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2. 
3. City Controller, 108 E. Green St., Ithaca, NY 14850
5. Company Legal Name*
7. Organization Type*

   1. Sole-Proprietor
   2. LLC

   1. General Partnership
   2. Limited Partnership

   1. Corporation
   2. S-Corporation
9. Mailing Address*
11. City*
12. State*
13. ZIP*
15. Email Address*
17. Website Address
19. Contact Person*
21. Federal ID Number*
23. Number of Employees*
24. Date Business Started*
26. Description of Goods and/or Services Offered*
28. Is the vendor a:*

    (Check all that apply)

    1. Women-owned Business Enterprise
    2. Disadvantaged Business Enterprise
    3. Minority Business Enterprise
    4. Provider of Environmentally Friendly Products / Services
    5. Local Vendor
    6. Other
30. If other:
32. An acknowledgement of receipt will be sent to the vendor. Thank you for your interest!
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field