Vendor Setup Request - Northwood University Forms

Vendor Description

Vendor Name *

(As registered with IRS)

Business Name/DBA

(If different from “Vendor Name”)

Parent Company Name

(If applicable)

Company Owner/Principal *

Vendor Type *

(Must provide proof of liability insurance and worker’s compensation coverage)

Description of Goods/Services *

Business Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Remittance Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone *

Company Fax

Website URL

Vendor Contact Name *

First Last

Vendor Contact Phone *

Vendor Contact Email *

Northwood Requester Name *

First Last

Requester Title *

Requester Department *

Requester Phone *

Requester Email *

Requester Fax

Relationship with vendor *

Northwood Authorizing Email *

Please enter the email address of the individual who will need to authorize this request.

Comments

This field is for validation purposes and should be left unchanged.