Vendor Request Form
Please complete this form for any new vendor you'll be utilizing. This form can be used for both individuals and companies.
BTAA Staff member requesting new vendor
First Name
Last Name
Vendor Name
*
Doing Business As (DBA), if applicable
Vendor Contact Name (individual responsible for providing financial information)
*
First Name
Last Name
Vendor Middle Initial (if available)
Vendor Website (provide link)
Vendor Address (needed to verify if vendor is already established)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vendor Contact Phone Number
Vendor Contact E-mail
*
example@example.com
If invoices will be submitted under a different vendor name or address, please supply this information below:
Please provide a brief description of product or service the vendor will provide:
*
Stakeholder group that will be using vendor:
*
Examples: VPFA, Women in Technology, Library Accessibility Alliance, etc.
Submit
Should be Empty: