Solicitation of Personal Protective Equipment and Other Emergency Goods and Services to Fairfax County

Thank you for your interest in selling emergency goods and services to Fairfax County. Please complete and submit this form to ensure that we are made aware of your offer. If your offer matches our needs, we will be in touch!

If there are questions to which you do not have the answer at this time, you may write "n/a".

If you have questions about how to complete this form, contact us via email or at (703) 324-3201 (TTY 711).

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* 1. Contact information

Name *

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. If available, you may provide your federal Tax ID Number and Virginia State Corporation Commission Entity ID

Federal Tax ID

VA SCC Entity ID

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* 3. List here the details of one product or service you are offering to sell. If a line item is not applicable, write "N/A".

Product or service

Description

Price

Minimum order quantity, if any

Any product certification or compliance with standards, if applicable

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* 4. Would you like to provide information on additional products or services?

Yes