Form Center

Applicant Information

Application Type*
Select one
1. New Application
2. Revised Application
Business Name*
Federal I.D.*
Date*
Date
First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State*
Zip Code*
Is this also the remittance address for payment?*
1. Yes
2. No
Remittance Address Line 1*
Remittance Address Line 2
City*
State*
Zip Code*
Type of Organization*
1. Individual
2. Partnership
3. Corporation
4. Non-Profit Organization
How long have you been in the present business?
Please indicate whether answer is in years, months, or days
Continue

Authorization
I certify that the information supplied herein, including all pages attached, is correct and that neither the applicant nor any person (or concern) in any connection with the applicant as a principal or officer so far as is known, is now debarred or otherwise declared ineligible by the City of Oldsmar to bid on furnished materials, supplies, or services for the City or any agency thereof.
Applicant's Signature*
Date*
Date
Title

Leave This Blank: