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Fill and Sign the New Vendor Form 34930214

Fill and Sign the New Vendor Form 34930214

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NEW VENDOR SET-UP REQUEST FORM Must Provide All Information Or Vendor Will Not Be Set-Up Vendor Information: Name Tax Id No. Address1 (PO Boxes must include a street address) Address2 Phone - - Fax - - City State Zip Country - Email Purchase Order Vendor? Principal Contact Name For Foreign Vendor - Is Work Performed in the U.S.? Yes Yes No No Describe Nature of Services Performed Expected Average Invoice Amount $ Will the Vendor accept the VISA Purchasing-Card? Yes No Purchase From or Remit Payment To (if different from address above): Address1 Address2 City State Zip - Country Approver must be Business Unit Controller or a designee Preparer's Name (print) _____________________________________ Controller/Designee (print) _____________________________ EIN_____________Legal Entity_______ Signature _________________________ Date ___________________ Phone No _________________ Accounts Payable Department Use Only Set-Up By _______________________ Date _________________ Vendor No. Assigned _______________ Received Form W-8BEN for Foreign Vendor? (circle one) Yes No PIRG Approval (invoices $2,000 and less) ______________________________________

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