Request for Vendor Information Form

Please access the Vendor Change Request form to submit changes to your existing vendor request application.

GENERAL INFORMATION

Please provide names and job titles of anyone employed by your company related to any one employed by our company or any of its affiliates.

BUSINESS STATUS INFORMATION

Please select the appropriate response below:

Business Status (select one) *

Corporations, Partnerships & Trusts
Individual
Sole Proprietors using an assumed business name

We are required by the IRS to keep IRS Form W-9 on file for all vendors. You can obtain a blank Form W-9 via the attached link: https://www.irs.gov/pub/irs-pdf/fw9.pdf

BANK INFORMATION FOR ACH PAYMENTS

REMITTANCE INFORMATION

AUTHORIZATION

I authorize V P Holdings or subsidiaries and the financial institution listed above to electronically deposit invoice payments into my bank account. If monies to which I am not entitled are deposited into my account by V P Holdings or subsidiaries, I authorize V P Holdings or subsidiaries to direct the bank to return said funds. This authorization will remain in effect until it has been cancelled in writing.

CREDIT CARD PAYMENTS

PRODUCTS OR SERVICES YOUR COMPANY PROVIDES

LIST 3 CREDIT REFERENCES

INFORMATION PROVIDED BY

Disclaimer: I agree that by typing my name and clicking submit, I am agreeing to and electronically signing this document and that it will be binding on me to the same extent it would be if signed by me in person.