National Park College
Vendor Information Form
Business Name:
Y N
Are you 1099 reportable?
Please fax or email a copy of your W9 to:
(501) 760-4220
Are you a Governmental or
Y N
accountspayable@np.edu
Not-For-Profit organization?
Telephone:
Are you incorporated?
Y N
Fax:
Website:
Address Information
Main
Address:
Do you accept PO’s?
Y
If yes, please provide email or fax:
N
City:
St: Zip:
Purchase Order
(If different from above)
Do you give quotes?
Y N
If yes, please provide representative email
or fax:
Address:
City:
St:
Remit
Address:
City:
St:
Zip:
(If different from above)
Zip:
Minority Indicator
(For reporting purposes only)
N/A
Asian/Pacific Islander American
American Indian/Native American
African American
Hispanic American
Service Disabled Veteran
The undersigned certifies that the information contained herein is correct. I understand that the form must be
complete or it will be returned. Vendors are added to the database based on the information provided from this form.
Misrepresentation may be cause for removal of my firm's name from the NPC vendor list.
Signed Title
