Template_-_New_Vendor_-_Modify_Request_Form.pdf

NEW VENDOR / MODIFY REQUEST FORM Page 1 of 2 Revised 11/2025

NEW VENDOR / MODIFY REQUEST FORM

Note: This form must be completed by the reques�ng vendor and signed by authorized personnel. The required suppor�ng documents along with this form must be provided to the responsible Collier County Division representa�ve.

Instruc�ons For Vendor The following documents are required and must be atached separately:

Adding a new vendor Change to an exis�ng vendor o Completed W-9 o IRS 501 (C)(3) for non-profit vendor o SunBiz registra�on confirma�on printout or State registration (out of FL companies), showing the company is currently ac�ve (including officer informa�on) o SunBiz registra�on confirma�on printout for Fic��ous Name confirming/showing the company is currently ac�ve o Collier County Tax Receipt (if physical address is within Collier County) o E-Verify Memorandum of Understanding or Company Profile (e-verify.gov) o Completed W-9 o SunBiz registra�on confirma�on printout confirming/showing the company is currently ac�ve (including officer informa�on) o E-Verify Memorandum of Understanding or Company Profile (e-verify.gov) o If either the W-9 or E-Verify is under a parent or affiliated company name, a letter from the parent company explaining the rela�onship is required

Instruc�ons For Division The following steps must be completed by the responsible Collier County Division:

Step 1: Review the completed request form by the vendor for accuracy, and digital signature(s)

Step 2: Verify all the required suppor�ng documenta�on are included

Step 3: Review SAP for vendor record

For new vendors, confirm an account does not exist For changes, confirm an update was not already made and add the SAP# to the form

Step 4: Submit to Procurement

The Division requester is responsible for reviewing all documenta�on before submi�ng the packet to the Procurement Services Division. Incomplete packets will be rejected.

Modifica�ons to banking details (ACH) will NOT be accepted using this form.

Please contact the Clerk of Court Finance team at payops@collierclerk.com.

https://sp16.bcc.colliergov.net/sites/procurement/SitePages/Home.aspx mailto:payops@collierclerk.com

NEW VENDOR / MODIFY REQUEST FORM Page 2 of 2 Revised 11/2025

SECTION ONE: REQUEST TYPE (Select One)

Adding a new vendor (iden�fy primary use):

General Vendor (EIN# Repor�ng) Land Non-Profit Standard – 1099 (SS# Repor�ng)

Law Firm

Change to an exis�ng vendor (iden�fy type of change):

Principal Order Address Remit Address Company Officer Email Address

Business Phone Corporate Status or Name Change (Inc., LLC, etc.)

TIN/EIN Number

SECTION TWO: VENDOR INFORMATION

Legal Vendor Name

Principal Order Informa�on:

Address City State Zip Code Phone Fax Email

Remit Informa�on (if the informa�on is the same as the Principal Order, skip the address fields below):

Address City State Zip Code Phone Fax Email

Officer of the Company:

Name Title

Signature

TO BE COMPLETED BY THE RESPONSIBLE COLLIER COUNTY DIVISION

If this is a new vendor request, is the vendor related to a Solicita�on, Contract, Waiver, Exemp�on, Piggyback, or Non-Standard Contract?

Yes No Bid/Contract Number:

Exis�ng vendor SAP Number:

SECTION THREE: DIVISION REQUESTER INFORMATION

Name Telephone Number

Email Division

The requester acknowledges that the vendor informa�on provided has been verified and confirmed with the company’s officer.

Verified by Signature