New Vendor ID - Setup Form
Please complete all fields. Incomplete forms could result in delay of payment(s).
Legal Company Name (as it appears on tax return)
*
DBA Company Name (or N/A)
*
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website Address
Remit-to-Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Customer Email Address (Required for confirmation)
*
example@example.com
Purchase Order Number(s) can be emailed to email address:
example@example.com
Attach a completed Form W-9
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If ACH/WIRE Transfer payment is being requested, please attach all banking and wiring instructions on COMPANY LETTERHEAD with this form.
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“Name of the person at KUA that needs to be notified when your new Vendor Profile setup is complete?”
KUA employee’s email address for notifications
example@example.com
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Vendor Signature
Your Name
*
First Name
Last Name
Title
Date
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Submit
Should be Empty: