BOSSIER PARISH COMMUNITY COLLEGE
VENDOR CREATE / MODIFICATION FORM
FAX FORM TO: 678-6402
Vendor Type (Choose one): _____Purchasing (V) _____Employee(E)
(CHOOSE ONE): _____Create New Vendor or _____Modify Vendor Information for Vendor # ___________________
ORDER MAILING ADDRESS PAYMENT REMIT ADDRESS
(Only If Different From Mailing Address)
Prepared by: _____________________________________________________ Date: ___________
Approved by: _____________________________________________________ Date: ___________
Vendor Number Assigned: ___________________________________________
Entered by: _______________________________________________________ Date: ___________
Vendor Name:
______________________________________
Federal Tax ID/Social Security Number:
______________________________________
(For Employee, System Generated Number)
Remit To
Address: _____________________________
_____________________________
_____________________________
_____________________________
City: ________________________________
State: _______
Zip Code: ________-_____
Telephone: ______-______-_________
Fax: ______-______-_________
Company
Contact: ____________________________
E-Mail: _______________________________
Vendor’s Terms:
Vendor Name:
______________________________________
Federal Tax ID/Social Security Number:
______________________________________
(For Employee, System Generated Number)
Order From
Address: _____________________________
_____________________________
_____________________________
_____________________________
City: _________________________________
State: _______
Zip Code: ________-_____
Telephone: ______-______-_________
Fax: ______-______-_________
Company
Contact: ____________________________
E-Mail: ______________________________
