Fillable Vendor Registration ? Vendor Registration (City of Aztec)

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Vendor Registration ? Vendor Registration (City of Aztec)

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File type: PDF

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BROWSE CITY OF AZTEC (NM) FORMS

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Vendor Registration v2020.0330
COMPANY INFORMATION
Current W-9 is required to be submitted with this form: https://www.irs.gov/pub/irs-pdf/fw9.pdf
COMPANY NAME: ______________________________________________________
COMPANY WEBSITE: ______________________________________________________
SALES INFORMATION
Contact: __________________________________________________________________
Address: __________________________________________________________________
City: ____________________________State: ________________ Zip: ________________
Phone: ______________ Fax: _________________ Email: _________________________
PAYMENT INFORMATION
EFT is available to all vendors
Address (if different than W-9)
____________________________________________________________________________
City: ____________________________State: ________________ Zip: ________________
Phone: _______________ Fax: ________________ Email: __________________________
Payment terms _________________________
OTHER COMPANY INFORMATION
NM CRS ID No: ______________________ NM Contractor’s License No.:_______________
City of Aztec Business License No: __________
Insurance certificate, listing City as additional insured, is required if work is to be completed on
City property. Minimum requirements:
General Liability - $1,000,000 CSL (Combined Single Limits)
Auto Liability - $1,000,000 CSL (Combined Single Limits)
Workers Compensation – Statutory limits pursuant to the New Mexico Workers
Compensation Act.
To receive notification of bids, quotes, the City of Aztec distributes information through Vendor
Registry. A link to Vendor Registry is available on
http://www.aztecnm.gov/purchasing/office.html
For Aztec Use Only
Vendor No:___________
City of Aztec
Vendor Information Form
acctspayable@aztecnm.gov
City of Aztec New
Request for Vendor Electronic Funds Transfer (EFT)
Authorization Form Change
Section One: Vendor Contact Information
Section Two: Vendor Banking Information
Vendor Name:
Bank Name:
Vendor Name as shown on bank account (if different from above):
Bank Address:
Address:
City/State/Zip:
City/State/Zip:
Bank Routing Number:
Contact Person:
Bank Account Number:
Telephone Number:
Account Type: Checking Savings
Email Address:
City Use Only
Date Entered:
Vendor No:
If information supplied above is a change request, please provide the following information:
Previous Bank Name:
Previous Bank Address:
Previous Bank Routing Number:
Previous Bank Account Number:
Account Type: Checking Savings
Section Three: EFT Email Notification
Notification of EFT payments will be sent as a pdf file via email when a payment has been issued, to the email address listed above.
To ensure that EFT Notifications are delivered to the email address provided, please add acctspayable@aztecnm.gov to your address book.
Section Four: Authorization Agreement - Please read and sign your name below.
I hereby authorize the City of Aztec (hereinafter "City"), to initiate credit entries to the account at the bank listed above for all vendor payments.
This agreement will remain in effect until I notify the City of the desire to cancel or change this service or until the City notifies me that this
service has been terminated. I understand I must allow reasonable time for my instructions to be executed. I authorize and request the bank
listed above to accept any credit entries by the City of Aztec to such account and to credit the same to such account. If the City credits more
money than the correct payment amount to the account, due to duplicate electronic funds transfers (where "duplicate" is defined as multiple
electronic funds transfers received for the same services rendered, the same membership and the same date of service) or erroneous
electronic funds transfers (where "erroneous" is defined as complete electronic funds transfers received in error), the City will attempt to
recover the duplicate or erroneous payment via a debit to my account to the extent permitted by state law.
By signing below, I hereby agree that I have read and agree to the terms and conditions stated above, including Authorization for
Direct Deposit Payments.
Date: Signature Title
Printed Name Phone Number
Send the completed form to the City of Aztec at: City of Aztec Or Fax To:
Attn: Finance Dept
505-334-7649
201 W Chaco
Aztec NM 87410
Vendor Registration v2020.0330
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Vendor Registration Vendor Registration (City of Aztec)

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Completed 14 July 2020

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