Vendor Registration Form

Company Contact
Company Name*
Point of Contact Name & Title*
Contact Phone 1*
Contact Email*
Mailing Address*
Website
Company Overview
General Details of Services / Goods*
Employer Identification Number / SSN*
TucsonPhoenixOther
Insurance Company*
Licensed Number (ROC)*
Type "N/A" if no license is available.
Additional Information
Banking Information
YesNo
Bank Name*
Beneficiary Name*
Account Number*
Routing Number*
Phone Number Associated with Account*
Bank Address*
Form Uploads

Form information can be found at the top of this page
W9 Tax Form Upload*

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Certificate of Insurance Upload*

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Certification
I hereby affirm that all information supplied is true and accurate to the best of my knowledge and belief, and I understand that this information will be considered material in the evaluation of quotations, bids, and proposals. Notice must be given of any change in status impacting the information provided within ten (10) days of said change.
Printed Name*
Title*
Signature
Date*

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By submitting this form, you acknowledge that you have read or had the opportunity to read the Privacy Policy and agree to be contacted by AZ Construction and Renovation by phone, text, or email.
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