SIMPLE VENDOR APPLICATION FORM

YOUR LOGO Company Name
Address Line 1
Address Line 2
Phone | Fax
Email

VENDOR APPLICATION FORM

VENDOR INFORMATION

COMPANY / FIRM NAME as shown on Federal Tax Return	VENDOR ID. if applicable
ALTERNATE NAME if applicable / (doing business as)	TAX ID NUMBER FEIN OR SSN
POINT OF CONTACT NAME	TITLE
VENDOR ADDRESS
PAYMENT ADDRESS if different from address above
PHONE	FAX	VENDOR EMAIL
TAX EXEMPT? Y or N	VENDOR WEBSITE

ORGANIZATION TYPE
Corporation	Individual / Sole Proprietor	Joint Venture
LLC	Partnership / Limited Partnership	Non Profit

Separate checks?	Accept purchasing card? e.g, Visa, MC, etc.	BANKING INFORMATION
YES	YES	ACCOUNT NO.
NO	NO	ROUTING NO.

REQUESTOR / VENDOR’S NAME	SIGNATURE	DATE REQUESTED / SENT

INTERNAL USE ONLY	VENDOR ID	DATE RECEIVED	DATE PAYMENT PROCESSED

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