New Vendor 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 Subcontracts
Contact Name

Purchase Orders and Subcontracts
Email Address

Billing/Accounts Receivables
Contact Name

Billing/Accounts Receivables
Email Address

Vendor Type
Select 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 Tax
Please Select From The Dropdown Menu.

Local Sales Tax
Please Select From The Dropdown Menu.

Remit To Address

City

State

Zip

Upload your W-9

Upload your Contractors License

Do you accept credit card payments?

Do you offer any discounts for early payment?

Suppliers, Select standard payment terms.

What scopes of work do you handle?

Name of Person Completing this Form

Email Address of Person Completing this Form

Address

104 Dairy Lane
Broussard, LA 70518
United States

Phone

(337) 427-6100

build@manuelcommercial.com