Vendor Application Form

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FEDERAL ID #
SS #
VENDOR #
VENDOR NAME
DATE
DOING BUSINESS AS
INCORPORATED?

		PURCHASE ORDER ADDRESS
NAME
STREET
P.O. BOX
CITY
STATE
ZIP
FEDERAL ID #
SS #

		REMITTANCE ADDRESS
NAME
STREET
P.O. BOX
CITY
STATE
ZIP

		QUOTATION ADDRESS
NAME
STREET
P.O. BOX
CITY
STATE
ZIP

COUNTY
E-MAIL
		ex: john@mycompany.com
CONTACT PERSON
CONTRACTOR'S LICENSE NO. (IF APPLICABLE)
PHONE
FAX
YEARS ESTABLISHED
TERMS OF PAYMENT
PAYMENT DISCOUNT AVAILABLE
IF YES, EXPLAIN
THIS FIRM CERTIFIES THAT IT IS A (IF APPLICABLE)

		CONTACTS
MANAGER
PHONE
FAX
SALES REPRESENTATIVE
PHONE
FAX
INSIDE SALES REPRESENTATIVE
PHONE
FAX
ACCOUNTS RECEIVABLE CONTACT
PHONE
FAX

		PRODUCT(S) AND/OR SERVICE(S)
TYPE
		Please list the type of product(s) and/or service(s) that your company can provide
NAME
TITLE
DATE

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