Unique Woman's Coalition Vendor's Form

Unique Woman's Coalition Vendor's Form
All vendors must have a completed packet on file for payment/reimbursement.

Allow 3-5 business days for payment.
1. Vendor's Name **
1A. Business Name (if applicable)
2. Vendor's Phone # **
3. Vendor's Complete Mailing Address (include City/State/Zip) **
4. Vendor's Email Address*
example@example.com
5. How would you like to receive payment?*

Mail check to the address in my vendor profile (Checks take up to 2 weeks)ACH Deposit (For electronic deposits, allow a minimum of 3 business days)
Banking Information

This section is only for ACH deposits
6. Routing Number
6A. Account Number
Enter your account number here
6B. Bank Name
Enter the name of your bank here
7. I agree the information I provided is correct*

YesNo
8. Date of Service **

MonthDayYear
Date
9. Name of project / Activity / Service **
Amount of invoice?*
Upload your invoice & W9 here

Cancelof
Would you like to make a donation to UWC? If so, please indicate the amount. $5, $20, $50, $100, (.
if you require a W9, visit the IRS website here https://www.irs.gov/pub/irs-pdf/fw9.pdf
Signature*

Clear
Should be Empty:

Banking Information