Small Works Roster Application

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This field is for validation purposes and should be left unchanged.

Date(Required)

Name of Business:(Required)

Contact Name:(Required)

Phone(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Type of Ownership:(Required)

Corporation

Single Proprietorship

Partnership

Minority and Women-Owned Businesses:

MBE

WBE

Licenses & Tax Identification

Washington State Tax No. (UBI):(Required)

City of Union Gap Business License:

Yes

License No:

Types of Services, Equipment or Products Provided:

Signature:(Required)

By signature below, I acknowledge that I have read and understand the requirements described in this application and to the best of my knowledge, information provided is a true representation of the named firm’s ability to perform any contracts which may result by submittal of this application.

Name and Title:(Required)

Date(Required)

Small Works Roster Application

Licenses & Tax Identification

For questions, please contact Lynette Bisconer (509) 248-0432