New Vendor Request Form 1

NEW VENDOR REQUEST FORM

Please provide the following information when submitting a request to create a new vendor and include a signed W-9 form.

Vendor Information: Vendor Name Vendor Address Vendor Contact Name Vendor Email address Terms Payment method

ACH

ACH Banking Information: Bank Account Number Routing Number Bank Name Bank address

Requested by: (print name) Name: __________________________ Title: ___________________________ Date: ___________________________

PIT-052925-HC-v1