New Vendor Form Be prepared to upload the following applicable items when completing this form. W-9Contractor’s License Please note, we will request your certificate of insurance upon receipt of this completed form. Legal Entity Name Business Name/Disregarded Entity Name, If Different From Above Website Office Phone Tax ID Number D-U-N-S Number (If you do not have one please put N/A) Authorized Signer 1 Name Authorized Signer 1 Email Authorized Signer 2 Name Authorized Signer 2 Email Address for Contracts and Notices City State Zip Purchase Orders and SubcontractsContact Name Purchase Orders and SubcontractsEmail Address Billing/Accounts ReceivablesContact Name Billing/Accounts ReceivablesEmail Address Vendor TypeSelect ALL that apply. Architect Engineer Rentals (equipment. dumpsters, etc) Subcontractor, Labor & Materials Subcontractor, Labor Only Supplier, Materials Only Are You A Licensed Louisiana Contractor? Select ALL that apply. If yes, you will need to attach your license in the attachment section below. No Yes, Louisiana Commercial Yes, Louisiana Residential Yes, Louisiana Home Improvement Yes, Louisiana Mold Remediation Louisiana Sales TaxPlease Select From The Dropdown Menu. I will collect and remit sales tax on items sold to your firm.I will not be collecting or remitting sales tax on items sold to your firm. Local Sales TaxPlease Select From The Dropdown Menu. I will collect and remit local taxes on items sold to your firm.I will not be collecting or remitting local taxes on items sold to your firm. Remit To Address City State Zip Upload your W-9 Upload your Contractors License Do you accept credit card payments? Yes, With a Fee.Yes, No Fee.No Do you offer any discounts for early payment? YesNo Suppliers, Select standard payment terms. Net 10Net 15Net 30Net 45Net 60Other What scopes of work do you handle? Name of Person Completing this Form Email Address of Person Completing this Form SUBMIT FORM
