Fillable Vendor Data Information (All blanks must be completed

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Vendor Data Information (All blanks must be completed

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Vendor Data Information (All blanks must be completed to be applicable)
Name_________________________________________________________________________
DBA__________________________________________________________________________
Physical Address________________________________________________________________
City___________________________________State____________________Zip______________
Remit to Address: ____________________________________________________________________
City______________________________________State______________________Zip_______________
Telephone #______________________________________Fax #_________________________________
Email: _______________________________________________________________________________
Social Security # or Tax ID #____________________________________ 1099 Yes ____ No ____
Upload this form here: http://bit.ly/3ifhE0z
Email: Sutterback@skillsusa.org
Fax: 703-777-8999
Mail: 14001 SkillsUSA Way, Leesburg, VA 20176
Office Use Only
Entered by: ________________________________ Approved by: ______________________________
Date: _____________________________________ Date: ________________________________
Direct Deposit Authorization (ACH Credit) Information required to complete the vendor setup process.
I, ___________________________________________________________________________________
authorize SkillsUSA, Inc to send an ACH credit to the account indicated below.
Account Type: Checking ______ or Savings _____ AND Personal ______ or Business _______
Bank Name____________________________________________________________________________
Bank Routing #_________________________________________________________________________
Account # ____________________________________________________________________________
Remittance Email(s)_____________________________________________________________________
Signature_____________________________________________________________________________
Date_________________________________________________________________________________
SkillsUSA School Chapter ID# ____________________________________________________________
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Vendor Data Information (All blanks must be completed

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Completed 24 February 2021

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