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2. 
   Orange County, Virginia
   Department of Management Services
   112 W. Main Street
   Orange, VA 22960

4. Date:*
5. Application Type:*
   -- Select One --New ApplicationName ChangeAddress Change

   Select all that apply
7. First Name:*
8. Last Name:*
10. Company Name:
11. Federal Tax ID Number:
13. Type of Business:
15. Description of Products/Services Offered:
17. Names and Titles of Representative(s) Authorized to Sign Bids & Contracts:
19. E-mail Address for Bid Notification:*
21. List of Current Cooperative Contracts & Contact Information:
25. Address1:*
26. Address2:
28. City:*
29. State:*
30. Zip:*
34. Application Authorization

    1. By checking this box, you authorize Orange County to accept this application.

    It is the resopnsibility of the company to keep their applications current and to notify the Procurement Coordinator when changes occur regarding the products or services offered, address, ownership, or status of a bidder. Placement on the Bidder's List does not guarantee a receipt of a solicitation request. It is the bidder's responsibility to check the bid notices posted on this website and eVA (Virginia's electronic procurement site located at http://www.eva.virginia.gov/). By checking the box you certifiy that the information supplied herein is correct and that neither the applicant nor any person in any connection with the applicant as a principal or officer, so far as it is known, is now disbarred or otherwise ineligible by any public agency from bidding for furnishing materials, supplies, or services to any agency thereof specified.
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

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