GovDeals - State of California Sign Up Form

State of California Sign Up Form
Agency Name:
Division:
Main Point of Contact
(Contact) Name:

First NameLast Name
(Contact) Title:
(Contact) Email:
(Contact) Phone Number:
Format: (000) 000-0000.
(Contact) Alternate Phone Number:
Format: (000) 000-0000.
(Contact) Address:

Street Address

Street Address Line 2

CityState

Zip Code
Accounting Contact

**Recipient and mailing address for check payments**
(Accounting) Name:

First NameLast Name
(Accounting) Title:
(Accounting) Email:
(Accounting) Phone Number:
Format: (000) 000-0000.
(Accounting) Alternate Phone Number:
Format: (000) 000-0000.
(Accounting) Address:

Street Address

Street Address Line 2

CityState

Zip Code
(Accounting) Make checks payable to:
Asset(s) Location

**Indicate the physical location of your asset(s)**
Is the asset(s) location the same as the Point of Contact address listed above?
Asset(s) Location Name:
Asset(s) Location Address:

Street Address

Street Address Line 2

CityState

Zip Code
Add Additional User(s)?
Do you have an additional user(s) to add?
How many?
Additional User #1
(Additional User #1) Name:

First NameLast Name
(Additional User #1) Title:
(Additional User #1) Email:
(Additional User #1) Phone Number:
Format: (000) 000-0000.
(Additional User #1) Alternate Phone Number:
Format: (000) 000-0000.
(Additional User #1) Address:

Street Address

Street Address Line 2

CityState

Zip Code
Additional User #2
(Additional User #2) Name:

First NameLast Name
(Additional User #2) Title:
(Additional User #2) Email:
(Additional User #2) Phone Number:
Format: (000) 000-0000.
(Additional User #2) Alternate Phone Number:
Format: (000) 000-0000.
(Additional User #2) Address:

Street Address

Street Address Line 2

CityState

Zip Code
Notice to Selling Agency: The State of California Department of General Services Office of Fleet and Asset Management will charge a fee of $295.00 on all Mobile Asset sales and a fee of 20% of the final sold amount on all other assets to the selling agency. GovDeals will remit sales proceeds, less the DGS fee to the selling agency via a paper check. GovDeals will remit the portion of the sales proceeds to be returned to DGS via separate payment made directly to DGS. By checking the box below, the selling agency agrees to these conditions.
Should be Empty:

State of California Sign Up Form

Main Point of Contact

Accounting Contact

Asset(s) Location

Add Additional User(s)?

Additional User #1

Additional User #2