New Vendor Form
Vendor Information
Name
First Name
Last Name
Tax ID Number
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Principal Contact Name
First Name
Last Name
Purchase order vendor?
Yes
No
Is work performed in the U.S?
Yes
No
Describe the nature of services performed.
Expected average invoice amount
Will the vendor accept the VISA purchasing card?
Yes
No
Purchase From / Remit Payment To
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preparer's Name
First Name
Last Name
Controller/Designee Name
First Name
Last Name
EIN
Legal Entity
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Accounts Payable Department Use Only
Set-up By
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Vendor No
Received from W-8BEN for foreign vendor?
Yes
No
PIRG Approval
Submit
Should be Empty: