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2. 

3. CITY OF WESTLAND

   Purchasing Department

   36300 Warren Road

   Westland, Michigan 48185

   Phone: (734) 467-7920

   Fax: (734) 422-1218

   Email: Purchasing@cityofwestland.com

5. Applicant's Information
7. Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Fax Number
19. Email Address*
23. Applicant's Bill To Information
    Applicant's Bill To Information If Different from Above
25. Name
27. Address
29. City
30. State
31. Zip Code
33. Phone Number
35. Fax Number
37. Email Address
41. Persons' Authorized to Sign Bids, Offers & Contracts
43. Person 1
44. Person 2
46. Name
47. Name
49. Title
50. Title
52. Address
53. Address
55. City, State, Zip
56. City, State, Zip
58. Phone Number
59. ext.
60. Phone Number
61. ext.
63. Fax Number
64. Fax Number
66. Email Address
67. Email Address
71. Organization Information
73. Name of Organization*
75. Federal/State I.D. Number*
77. Give a brief description of commodities and services offered:
79. Type of Organization

    1. Individual

    1. Corporation

    1. Non-Profit

    1. Partnership
81. Attach any relevant documents and W-9
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field