HR Vendor Maintenance Request Form

HR Vendor Maintenance Request Form

Use this form to request addition, update, reactivation, or deactivation of a vendor record used by Human Resources and related payroll or benefits processes. Complete all applicable fields and attach required documentation. Incomplete submissions may be returned for clarification.

Requester Personal Information

Manager:    Office Phone:

Vendor Identification

Federal Tax ID / EIN:    Vendor Code (if existing):

Vendor Contact & Services

Contact Phone:    Contact Email:

ACH / Electronic Transfer    Check    Corporate Card    Other

Request Type & Reason

Add New Vendor    Update Existing Vendor    Deactivate Vendor    Reactivate Vendor

Required Documentation Checklist

W-9 or equivalent taxpayer document on file    Certificate of Insurance on file    Executed contract or SOW on file

Compliance Declarations (Vendor Representations)

By submitting this request, requester represents that, to the best of their knowledge, the vendor:

1. Is legally authorized to do business and will comply with all applicable federal, state, and local laws and regulations in providing goods or services. 2. Will maintain required insurance and indemnify the company for claims arising from vendor performance to the extent set forth in any executed agreement. 3. Will safeguard employee personal information and, where applicable, comply with data protection obligations and confidential information protocols set by the company.

The requester understands that adding or changing vendor data may affect payroll, benefits, or tax reporting and agrees to provide accurate documentation to support tax treatment and payment processing.

Requester Employment History (Required)

Provide your two most recent employers for verification purposes.

Title:    Start Date:    End Date:

Title:    Start Date:    End Date:

Education

Professional References

Phone:    Email:

Phone:    Email:

Phone:    Email:

Legal Notices & Employment Statements

At-Will Employment Statement: Employment relationships remain at-will unless a written contract signed by an authorized representative specifies otherwise. Nothing in this vendor maintenance request alters the at-will nature of any employment relationship.

Equal Opportunity Statement: The company provides equal employment opportunity without regard to protected characteristics. Requests to add or change vendors will be evaluated consistent with company policy and applicable law.

Certification & Authorization

I certify that the information provided on this form and accompanying documentation is true, complete, and accurate. I understand that knowingly providing false or misleading information may result in disciplinary action. I authorize Human Resources and Procurement to verify the information supplied, contact listed references and prior employers, and perform checks necessary to validate vendor and requester credentials in accordance with company policy.

I acknowledge that approval of this request does not constitute a contractual commitment to purchase goods or services. All engagements with vendors remain subject to standard procurement and contracting processes, insurance, indemnity, and compliance requirements.

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