Vendor Information Form Clark University


Vendor Information Form
Contact Information:
Company/Vendor Name:_________________________________________________________________________
Contact Person:________________________________ E-mail Address:___________________________________
Phone #:______________________________________Fax #:___________________________________________
IMPORTANT: Please attach a completed copy of IRS form W-9: Request for Taxpayer Identification Number and Certification.
Payments Should Be Mailed To:
Mailing Address:_________________________________________________________________________________
City, State & Zip Code:____________________________________________________________________________
Please check the type of transactions you will be paid for:
_____Goods/Materials Only
_____Goods/Materials and Services
_____Services Only
Brief Description of Good/Services: __________________________________________________________________
General Terms for Doing Business with Clark University
All credit purchases originating from Clark University must either be accompanied by a purchase order signed by an
authorized Clark employee or paid with a valid Clark University procurement card (VISA card). Purchase Orders for
$500 or over also require a signature from the Planning and Finance Office. Any purchase made without the
issuance of an approved University purchase order or valid University procurement card shall be considered an
unauthorized purchase. Such purchases are non-binding to Clark University.
Payment terms for the College are considered to be Net 30 unless otherwise agreed upon. Vendors are encouraged
to provide cash discount terms on their invoices.
By completing this vendor application, the company listed below shall be added to the University’s vendor database,
however completing this application is not a guarantee of future business or solicitation.
I have read and understood the terms above and I certify that I am authorized to sign this document on behalf of the
company/vendor named above.
Name (Print)
Authorized Signature


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Parent category: Business