Fillable Vendorregform

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Vendorregform

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The Vendorregform form is 1 page long and contains:

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  • 36 other fields

Country of origin: OTHERS
File type: PDF

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Mailing Address
(Street/P.O. Box, City, State & Zip):_________________________________________________________
Contact Name:____________________________ Phone# (_____)________-_________________
Fax# (_____)________-_________________
Remittance Address
(Street/P.O. Box, City, State & Zip):_________________________________________________________
Contact Name: ____________________________ Phone# (_____)________-_________________
Fax# (_____)________-_________________
Company Name: _____________________________
Taxpayer ID: FEIN: ____________________________
Individual’s Name: ____________________________
SSN: ____________________________
Type of ( ) Agency ( ) Corporation ( ) Employee ( ) Federal Agency
Business: ( ) State Agency ( ) Local Government ( ) Partnership ( ) Proprietorship
( ) Self
( ) Other – Please Explain: _________________________________
( ) Independent Contractor – OPERS Reportable Job Title:___________________
Small Business? ( )Yes ( )No
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Vendorregform

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Completed 17 June 2022

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