If you buy a reference card, you'll get the exact same card from whatever vendor you purchase from. They might have different stickers, but under the hood, you're getting the same thing. That being the case, your biggest considerations should be price and customer service.
If you buy a non-reference card, as Shadow noted, it's going to be different than the non-reference cards of another manufacturer. The GPU itself will be the same, but (again, as Shadow noted) you're likely to see different cooling systems (more fans, different ventilation/heat sinks, water blocking, etc.) and a certain degree of factory overclocking. While the guts are the same, non-reference cards bring additional factors into the equation. Are you planning to overclock heavily? Then you might want to stick with a manufacturer like Sapphire, who place a great deal of emphasis on efficient cooling. If you aren't looking to overclock, or already have great airflow/cooling in your case, then you may not need to spend extra on a non-reference board. It all comes down to what you need, what's available, and how much you want to spend.
Whether you want/need a non-reference card or not, as a general rule, HIS, Sapphire, and XFX all have a great reputation for outstanding customer service. XFX offers a lifetime warranty on their cards, while most other manufacturers will offer 1-3 years. Whether or not a lifetime warranty is worthwhile is a subject of some debate, but that's a matter for a different thread. Diamond, on the other hand, seems to have a reputation for pretty lousy customer service. You won't get a card from them that's cheap enough (compared with the competition) to justify the nightmare you might experience if you had to try and RMA a card.
Hope that helps, and again, hat tipped to shadow for his info - +1 to all of it.