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.
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: