Fillable Vendor Request Form Revised 2019 (City)

Fill Online, Printable, Fillable, Blank Vendor Request Form Revised 2019 (City) Form

Use Fill to complete blank online CITY (AR) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Vendor Request Form Revised 2019 (City)

On average this form takes 10 minutes to complete

The Vendor Request Form Revised 2019 (City) form is 1 page long and contains:

  • 0 signatures
  • 23 check-boxes
  • 30 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City

BROWSE CITY (AR) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
VENDOR REQUEST FORM
2017 HR/Vendor Request Form
This form is to be completed by the requesting department. This form should accompany all W-9 forms that are submitted to the
Department of Finance (Purchasing).
PROSPECTIVE VENDOR INFORMATION
Vendor’s Name/Company:
Address:
Is this prospective vendor a current City of Little Rock
employee? Yes No
If yes, please attach approval from the City Manager.
Telephone:
SSN/Federal Employee ID Number/Individual Taxpayer ID Number:
Contact:
Email Address:
Check appropriate box:
Individual/Sole Proprietor
C Corporation
S Corporation
Partnership
Limited Liability Company
Trust/Estate
Reimbursement
Non-Employee Travel
Other _________________
Minority Status (if applicable)
African American Owned
Women Owned
Other ____________________
Minority Certification Status (if applicable)
Certified
Certifying Entity __________________________
Certification Number ______________________
Briefly describe the nature of the service to be provided or provide the reason or explanation the individual should be set up as
vendor (i.e. reimbursement, non-employee travel, etc.).
Period of Service (Permanency of the Relationship):
Start Date: / /
End Date: / / Other:
Payment Terms:
Will this prospective vendor provide a one-time service or will the
service be recurring and/or intermittent?
One-Time Service Recurring and/or Intermittent
Do you provide this service to anyone other than the City of Little Rock?
YES NO
DEPARTMENT INFORMATION
Department:
Division:
__________________________________________________________________________________________________________
Signature of Departmental Representative with Job Title Date
responsibility for service to be provided
FINANCE DETERMINATION Vendor Class: Income Code:
This prospective vendor is approved to be set up as a vendor.
This service has been pre-determined to be treated as an independent contractor. (i.e. officials, umpires)
This prospective vendor should be evaluated further, this form will be forwarded to the Department of Human Resources
for final determination.
Reviewed by:
_________________________________________ _________________________________
Finance Representative Date
HUMAN RESOURCES DETERMINATION
This individual/sole proprietor is approved to set up as a vendor.
This individual/sole proprietor is NOT approved to set up as a vendor.
This prospective vendor should be evaluated further, please complete the Employee/Independent
Contractor Form and return to Human Resources.
Reviewed by:
_________________________________________ _________________________________
Human Resources Representative Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Vendor Request Form Revised 2019 (City)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document