Fillable Request For New Vendor No Form 10-14-11doc ARKANSAS TECH UNIVERSITY

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Request For New Vendor No Form 10-14-11doc ARKANSAS TECH UNIVERSITY

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ATU REQUEST FOR NEW VENDOR NO. Date:
BEFORE ENTERING YOUR REQUISITION, provide all information available and fax this form to the
Purchasing Department (968-0633). Purchasing will contact the vendor for their Tax Identification
Number, Business Designation, etc., set up the vendor in the Banner System, note the assigned vendor
number and return this form to the fax number listed below. If you have questions or need assistance,
please call 968-0269.
From:
(Department Name) (Departmental Fax No.)
Name of Company
or Sole Proprietor
Dba
(Doing business as)
Street Address
PO Box
City, State, Zip
Telephone Number
(IF UNKNOWN MARK N/A)
Fax Number
If fax number is unavailable, forms will be mailed or emailed.
Web Site
E-mail Address
REASON FOR NEW
VENDOR NUMBER
PLEASE CHECK ONE OF THE FOLLOWING
Place Order Game Official Stipend
Travel Reimbursement Refund/Other Reimbursement
IS THIS PERSON A
TECH STUDENT?
Yes No
BUSINESS
DESIGNATION
(IF KNOWN)
PLEASE CHECK ONE OF THE FOLLOWING
Foreign
Individual Sole Proprietor
LLC Corporation Partnership
Medical Non-Profit
Requested By:
(Signature)
Approved By:
(Signature of Immediate Supervisor)
FOR PURCHASING USE:
FEIN, TIN or SSN:
Date
Entered
Assigned Vendor No:
Initials
Form ATU-083 Revised 10-14-11
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Request For New Vendor No Form 10-14-11doc ARKANSAS TECH UNIVERSITY

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Completed 22 March 2020

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