h-gac.com / hgacbuy.org Serving Today • Planning for Tomorrow Authorized Retailer-Distributor-Dealer HGACBuy
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HOUSTON-GALVESTON AREA COUNCIL COOPERATIVE
PURCHASING PROGRAM
PLANNED AUTHORIZED RETAILERS/DISTRIBUTORS/DEALER FORM
P
rovide a listing of all planned authorized retailers/distributors/dealers, etc. that may be used during the term of this contract to deliver goods or services. NOTE: awarded contractor remains responsible for all applicable terms of the contract. Form can be duplicated as necessary to include all companies anticipated.
Company Name
Address
City State Zip
Phone Number Fax Number
Contact Person
Authorized Product/Service
Tax ID (Attach W-9)
Company Name
Address
City State Zip
Phone Number Fax Number
Contact Person
Authorized Product/Service
Tax ID (Attach W-9)
S
tate Zip
Fax Number
Company Name
Address
City
Phone Number
Contact Person
Authorized Product/Service
Tax ID (Attach W-9)