New Vendor/Vendor Update

New Vendor/Vendor Update
Complete the below form if you are requesting a new vendor setup, or to update the mailing address or contact information for an existing vendor. Information on this form is subject to additional verification to ensure accuracy and prevent fraud. For new vendors, a W-9 must be submitted along with this completed form.
VENDOR INFORMATION

New RequestChange Request
VENDOR NAME*
TAXPAYER ID (Required)*
Address*

ADDRESS

Street Address Line 2

CITYSTATE

ZIP
ACCOUNTING CONTACT NAME
Telephone Number*
FAX NUMBER
EMAIL ADDRESS *
example@example.com
REMTTANCE ADDRESS IF DIFFERENT FROM ABOVE
Address

ADDRESS

Street Address Line 2

CITYSTATE

ZIP
Certification:
I certify I am responsible for notifying any changes to the information provided above to Carroll County Government. I certify that the information above is true and correct, and that I am a representative for the above-named company.
Upload W9

Cancelof
Authorization:
Authorized Official Name*
Signature*

Clear
Title
Date

MonthDayYear
Date
Should be Empty: