Fillable Ulster County Vendor Information Request PLEASE RESPOND WITHIN (County of Ulster)

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Ulster County Vendor Information Request PLEASE RESPOND WITHIN (County of Ulster)

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The Ulster County Vendor Information Request PLEASE RESPOND WITHIN (County of Ulster) form is 4 pages long and contains:

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File type: PDF

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BROWSE COUNTY OF ULSTER (NY) FORMS

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Ulster County Vendor Information Request
Failure to accurately fill out the Vendor Information Request Form may result in delays of order and/or payment processing.
attached a completed and signed Form W-9, Request for Taxpayer Identification Number (TIN) dated within 90 days of submission
to your response e-mail
For further information, please email us at vendor.purchasing@co.ulster.ny.us or contact us by phone at (845) 340-4052.
Notes and Instructions:
Please avoid handwritten responses. Electronic responses are preferred. If you will be mailing or faxing this form, please complete it online BEFORE
printing out the hard copy.
Electronic responses are preferred. Upon completion of this form, please click the Submit button. You will be asked to indicate what type of email you
are using. Please read the instructions for each, as you may be required to save the completed form, then attach it along with the completed Form W-9,
to your response email.
All applicable parts of this Vendor Information Request Form and the required attachment(s) (see checklist below) must be completed and submitted or
the processing of any orders and/or payments may be delayed.
If you operate under an assumed business name (D/B/A) different from the name used on your income tax form (from W-9), you must submit a copy of
your Certificate of Filing and enter that name in the "D/B/A - Business Name" box on this form.
Please provide us with a Primary Contact as well as contact information for assistance with Purchase Orders, Remittances, Sales, Accounting, and/or
Shipping/Receiving. If you have multiple remittance addresses or some other contact information you wish to provide, please enter them on the last
page of this form.
Checklist:
BEFORE sending your response, please verify that you have :
County of Ulster
PO Box 1800
Kingston, NY 12402
Fax: (845) 340-3430
Email: vendor.purchasing@co.ulster.ny.us
Email (preferred), mail or fax:
Ulster County has implemented a new financial management system and we are requesting that you, a vendor of Ulster County, provide
us with up-to-date information by completing and returning this form. Please review the Notes and Instructions section below which
includes additional information with regard to this request. In addition, please provide us with a "Form W-9, Request for Taxpayer
Identification Number (TIN)" dated within 90 days of submission. We have included a blank Form W-9 as an attachment to this email.
Please complete the Form W-9, print, sign, scan and attach it to your response email.
completed, and if using Internet email, saved and attached this Vendor Information Request Form to your response e-mail
attached a copy of your Certificate of Filing (For D/B/A vendors only)
Be sure to attach a completed signed W-9 and your Certificate of Filing (if applicable) , then email, mail or fax to the
address/fax# above .
PLEASE RESPOND WITHIN 5 BUSINESS DAYS
PART 1: GENERAL INFORMATION
VENDOR NAME (Items with an * are required)
*Last Name -or- Business Name (Individuals entering Last Name must enter First Name below)
Primary Contact Information (Items with an * are required)
*Contact Name
*Address Line 1
Address Line 2
Address Line 3
*Zip Code
*City
Web Site Address
Purchasing Contact Information (Items with an * are required if you are completing this section)
PART 2: ADDITIONAL CONTACT INFORMATION
Same as Primary Contact Info above
*Email Address
*Phone Number
Extension Fax Number
Address Line 3
Address Line 2
*Address Line 1
*Contact Name
*State
D/B/A Business Name (from Form W-9 Business Name box, if applicable)
State Tax ID
*Federal Tax ID or SS #
First Name
Middle Name
Federal Tax ID
Soc Sec Num
Select one:
Suffix
P.O.'s can be emailed to this email address?
P.O.'s can be emailed to this email address?
*Email Address
*Phone Number
Extension Fax Number
*City
*Zip Code
Remittance Address & Contact Information (Items with an * are required if you are completing this section)
Same as Primary Contact Info above OR
Same as Purchasing Contact Info above
Address Line 3
Address Line 2
*Address Line 1
*Contact Name
Fax Number
Extension
*Phone Number
*Email Address
*City
*Zip Code
Primary 1099 Contact Information (Items with an * are required if you are completing this section)
Same as Primary Contact Info above OR
Same as Purchasing Contact Info above OR
Same as Remittance Contact Info above
*Contact Name
*Address Line 1
Address Line 2
*City
*Zip Code
Fax NumberExtension
*Phone Number
*Email Address
*State
*State
*State
Address Line 3
P.O.'s can be emailed to this email address?
P.O.'s can be emailed to this email address?
Fax Number
Extension
*Phone Number
*Email Address
*State
*City
*Zip Code
Address Line 3
Address Line 2
*Address Line 1
*Contact Name
Please use these sections to provide us with additional remittance information, if necessary
Fax Number
Extension
*Phone Number
*Email Address
*State
*City
*Zip Code
Address Line 3
Address Line 2
*Address Line 1
*Contact Name
Other Contact Information
PART 3: ADDITIONAL REMITTANCE CONTACT INFORMATION
*Description
P.O.'s can be emailed to this email address?
P.O.'s can be emailed to this email address?
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Ulster County Vendor Information Request PLEASE RESPOND WITHIN (County of Ulster)

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Completed 18 July 2020

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