BAY COUNTY VENDOR SET UP REQUEST
Return completed form to: Bay County Purchasing
515 Center Avenue, Suite 701,
Bay City MI 48708
Fax: 989-895-4178
THIS SECTION IS TO BE COMPLETED BY THE BAY COUNTY DEPARTMENT REQUESTING THIS VENDOR SET-UP
Requesting Department or Contact Name: _______________________________________________________________
Authorized Department Signature: __________________________________________________Date: ______________
New vendor? Yes No Unsure If no, vendor number: ______________________
One-time vendor? Yes No Unsure
Refund payment? Yes Restitution? Yes
Bay County employee? Yes No
Information change only? Yes If yes, fill out information change(s) only.
Check
next to change, below.
**THIS SECTION MUST BE COMPLETED BEFORE THE VENDOR WILL BE SET-UP
Vendor Name: __________________________________________________________________________________
DBA: _____________________________________________________________________________ Not applicable.
Contact Person Name:_____________________________________________________________________________
Contact Person Phone:__________________________________ Fax: ____________________________________
Contact Person Email: _____________________________________________________________________________
Vendor Address: _________________________________________________________________________________
Vendor Payment Address, if different from above: ______________________________________________________
Email to receive purchase orders electronically:_____________________________________________
__________
Page 1 of 3 Revised November 2018
INSTRUCTIONS: Bay County Vendor Set Up Request form is in three (3) parts.
All three parts are MANDATORY
Page 1 of 3: - Includes vendor identification and contact information.
Page 2 of 3: - Electronic Payment Set Up Request. Not available to one-time vendors.
Page 3 of 3: - W-9 form.
An incomplete form will NOT be processed.
Bay County Use Only Vendor No.: __________
Review Date: _________ Reviewer’s Initials: _____
1099: Yes No
1099:
3-Per Diem 6-Medical 7-Atty/Non-Employee Comp
Not on Debarment Suspension List
DUNS Number: _______________________________________________________
Service: ____________________________________________________________________________
Product/Supply: _____________________________________________________________________
Attorney
Medical
Not Applicable
Requesting Department or Contact Name: ____________________________________________________________
Authorized Department Signature: __________________________________________Date: ______________
New vendor? Yes No Unsure If no, vendor number: ___________________
One-time vendor? Yes No Unsure
Refund payment? Yes Restitution? Yes
Bay County employee? Yes No
Information change only? Yes If yes, fill out information change(s) only.
Check
next to change, below.
click to sign
signature
click to edit
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