Attachment_B_-_Domestic_Vendor_File_Form.doc
DOC document 161 KB Posted
- Attached to
- Answering Service Federal contract opportunity
- Solicitation number
- PC-18-Q-112
- Issued by
- Peace Corps
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| File | Type | Posted |
|---|---|---|
| Attachment_C_-_Pricing_Table.xlsx | XLSX spreadsheet | |
| Attachment_D_-_Call_Volumes.docx | DOCX document | |
| Request_for_Quote_(RFQ)_COU_Answering_Service_PC-18-Q-112.pdf | ||
| Attachment_A_-_SOW_Answering_Service.pdf |
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Text version
Domestic Vendor File Request Form Today’s Date / /
PRIVACY ACT STATEMENT: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31CFR 208 and 210. This information is used by Peace Corps and the U.S. Treasury Department to transmit payment data, by electronic means to a vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Electronic Funds Transfer (EFT) Program.
Requester INFORMATION
Last Name:
Edwards First:
Trevor
MI:
E-mail:
tedwards@peacecorps.gov
Office Name:
| Phone No.: (202) -6922647 |
| Reason for Request (Please check one box): FORMCHECKBOX |
New FORMCHECKBOX Update
Indicate Reason for Update New contract
Vendor Type: FORMDROPDOWN
*Agency ALC:
Vendor INFORMATION
| Vendor Name: |
| First: |
| MI: |
Job/Position/Title:
| Birthdate: / / |
| SSN or TIN: |
| Vendor DUNS: |
Gender: FORMCHECKBOX
M FORMCHECKBOX
F
| Phone No.: ( ) |
| Peace Corps E-mail Address: |
Address:
| City: |
| State: |
| Zip Code: - |
| Country: |
Financial Institution INFORMATION
Payment by: FORMCHECKBOX
EFT FORMCHECKBOX
Check
Justification required for check payment:___________________________________________________
If check, is the “Remit to Address” different? If different, provide the “Remit to Address” in the lines below.
Bank Corporate Name:
Branch Name:
Address:
| City |
| State: |
| Zip Code: - |
| Country: |
ABA# Nine-Digit Routing Transit Number (Swift Code, Clearing Code, Sort Code, etc.):
Depositor Account Number:
Type of Account: FORMCHECKBOX Checking FORMCHECKBOX Savings FORMCHECKBOX Lockbox
Other Vendor Information (For Internal Peace Corps Use Only)
FORMCHECKBOX
1099 (PSCs, Partnerships and Corporations)
FORMCHECKBOX
Non-1099 (Employees, Overseas staff, and Orgs)
| Completed By: |
| Date: / / |
| Vendor No: |
PC-CFO-FS-709 (02/2007)
File details come from the government source that posted it.