Vendor Information Form Clark University printable pdf download

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

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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

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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,

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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)

Title

________________________________________

______________________

Authorized Signature

Date

Vendor Information Form Clark University