• CMHPSM New Vendor Form

  • or

  •  -
  •  -
  • All CMHPSM vendors must submit a signed W-9 form and upload it below.

  • Link to fillable PDF copy of W-9 form: Federal W-9 Form

  •  -
  • All CMHPSM vendors will be paid through an electronic direct payment via ACH, instead of paper checks, unless the CMHPSM approves a paper check for an emergency or as an exception.

  • I understand this authorization remains in effect until cancelled by the Vendor or the CMHPSM. I authorize the CMHPSM to recover money electronically deposited in error by either debiting my account or by adjusting future payments.  I understand I will be notified if an error does occur.  Michigan law governs electronic funds transactions authorized by this agreement in all respects except as otherwise superseded by federal law.

    Vendor agrees to these stipulations by checking the agree box or signing or typing in the signature box:  

  •  -  - Pick a Date
  • Should be Empty: