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*Request for Information <br />To expedite service, please complete the following blanks relevant to your agency's administrative/elective <br />personnel and return the completed form to H-GAC, Cooperative Purchasing Program, P.O. Box 22777, <br />Houston, TX 77227-2777. <br />Name of End User Agency: County Name: <br />(Municipality / County / District / etc.) <br />Mailing Address: <br />(Street Address/P.O. Box) (City) (State) (ZIP Code) <br />Main Telephone Number: ( ) - FAX Number: ( ) - <br />Physical Address: <br />(Street Address, if different from mailing address) (City) (State) (ZIP Code) <br />Web Site Address: <br />Authorized Official: Title: <br />(City manager /Executive Director / etc.) Ph No.: ( ) <br />Mailing Address: Fx No.: ( ) <br />(Street Address/P.O. Box) E-Mail Address: <br />(City) <br />(State) (ZIP Code) <br />Official Contact: Title: <br />(Purchasing Agent/Auditor etc.) Ph No.: ( ) <br />Mailing Address: Fx No.: ( ) <br />(Street Address/P.O. Box) Email Address: <br />(City) <br />(State) (ZIP Code) <br />Official Contact: Title: <br />(Public Works Director/Police Chief etc.) Ph No.: ( ) <br />Mailing Address: Fx No.: ( ) <br />(Street Address/P.O. Box) Email Address: <br />(City) <br />(State) (ZIP Code) <br />Official Contact: Title: <br />(EMS Director/Fire Chief etc.) Ph No.: ( ) <br />Mailing Address: Fx No.: ( ) <br />(Street Address/P.O. Box) Email Address: <br />(City) <br />(State) (ZIP Code) <br />