New Vendor Application Form

NEW VENDOR APPLICATION FORM
Please complete this form and the attached W-9 then return both via fax at (225)222-4937 or email (bkleinpeter@sthpk-12.net Both forms must be filled out completely.
Company Name
"Remit To" Address
City
State
Zip
Purchase OrderMailing Address
City
State
Zip
Phone Number
Format: (000) 000-0000.
Fax Number
Email Address
example@example.com
Web Address
FaxEmail
Minority Business Enterprise (MBE)Disadvantaged Business Enterprise (DBE)Business (SDOV)Women Business Enterprise (WBE)Service-Disabled Veteran Owned
Occupational License Number
If you would like to receive payments by ACH, complete the following:
Bank Name
ABA/Routing Number
Account Number
Account Name
Should be Empty: