Entity Name: *
Federal Tax ID (EIN) Number:
Type of entity/organization:
*
City or Township
College / University
Cooperative
Corp (Non-profit / Governmental)
Corporation
Country
County
Federal Agency
Federal Department
Fire Department
Flood Control District
Government Buying Group
Highway Department
Highway Patrol
Home Rule City
Homeland Security Department
Hospital Authority
Hospital District
Hospital Group (non-profit)
Levee Improvement District
Municipal Improvement District
other
Police Department
Public Improvement District
Public Safety Department
River Authority
Sheriffs / Constables Dept
State
State Agency/Authority
Tax Increment Fin District
Toll Road Authority
Transit Agency
Utility Department
Waste Water Treatment
Water District
Other Specify:
First Name:
*
Last Name: *
Title or Position:
*
Email Address: *
Retype Email Address:
*
Password (min of 6 chars) :
*
Confirm Password:
*
Address1:
*
Address2:
City:
*
State:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
Tribal Governments
U.S. Virgin
Zip Code:
*
Country:
*
United States
Canada
Mexico
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Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
Chile
China
Columbia
Comoros
Congo
Congo, Democratic Republic
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Cote dlvoire
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Tuvalu
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uraguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Yemen
Zambia
Zimbabwe
Province:
*
Phone:
*
Primary Job Responsibility:
Purchasing Agent
Advisory Board
City/County Manager/Exec. Officer
Consultant
Council Member or Board of Directors
Department Head
Engineer
Management Team
Mayor
Purchasing Decision Maker
Staff
Supervisor's Name (if any) :
Purchasing Authority:
*
< $1,000
< $5,000
< $10,000
< $25,000
< $50,000
< $100,000
< $250,000
< $500,000
< $1,000,000
< $5,000,000
< $10,000,000
> $10,000,000
Preferred Language:
English
Memberships in which organizations or associations?
Products you expect to procure over next 12 months (To select multiple, press and hold Ctrl key) :
Aerial-Lift Trucks
Airport Security equip
Automobiles (non-police)
Backup power supply
Building Security equip
Concrete conduit
Construction ReBar
CT-scan equip (Hosp)
Elec generating equip
Emergency Serv Vehicles
Fire trucks
Garbage Trucks
Heavy Construction equip
Highway barriers
Motor fuels
MRI equip (Hosp)
Police Boats
Police cars/trucks
Police Helicopters
Police motorcycles
School buses
Service Trucks
Temp school buildings
Traffic signaling
Transit buses
Transit rail
Transit rail cars
Water treatment chem
Surplus equipment you expect to sell over next 12 months (To select multiple, press and hold Ctrl key) :
Aerial-Lift Trucks
Automobiles (non-police)
Backup power supply
Building Security equip
CT-scan equip (Hosp)
Elec generating equip
Emergency Serv Vehicles
Fire trucks
Garbage Trucks
Heavy Construction equip
MRI equip (Hosp)
Police Boats
Police cars/trucks
Police Helicopters
Police motorcycles
School buses
Service Trucks
Traffic signaling
Transit buses
Transit rail cars