Blank_New_Vendor_Form.xls
XLS spreadsheet 33 KB Posted
- Attached to
- Dental Hygienist
- Solicitation number
- TJCC2014-006
About this file
New Vendor Form
View the file
Other files
| File | Type | Posted |
|---|---|---|
| TJCC2014-006_Center_Dental_Hygienist.docx | DOCX document | |
| TJCC2014-006_Scope_of_Work _Dental_Hygienist.docx | DOCX document | |
| W9_Form.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
A
| ACCOUNTS PAYABLE NEW / CHANGE SUPPLIER FORM | ||
| Please type or print - All new suppliers require the approval of the Operation Executive Director or Center Director | ||
| ***FOR RESOURCE CENTER OFFICE USE ONLY*** | ||
| Supplier Number (assigned in Oracle) | ||
| 1099 Supplier Type (Check One) | ____ 1099 VENDOR | |
| ____ NON 1099 VENDOR | ||
| ____ EMPLOYEE | ||
| ***Complete All Fields Below*** | ||
| ResCare Operation Name | ||
| Supplier Name (Check Payable to) | ||
| Supplier Address Line 1 | ||
| Supplier Address Line 2 | ||
| City & State | ||
| Zip Code | ||
| Inactivate Old Address (Y or N) | ||
| Telephone Number | ||
| Fax Number | ||
| Email Address | ||
| Supplier Payment Terms (Check One) | ___ Client Payroll / Allowance | ___ Petty Cash & Accts Rec |
| ___ Consultants / Contractors | ___ Postage | |
| See payment terms & details below | ___ Direct Care Providers | ___ Rent / Lease |
| ___ Dues / Seminars | ___ Taxes | |
| ___ Employees / Students | ___ Utilities / Communications | |
| ___ Default (Net 35) | ||
| Foster Care Providers | ___ Check here if supplier is a qualified foster care provider | |
| Organization Type (Check One) | ____INDIVIDUAL | ____PARTNERSHIP |
| ____CORPORATION | ||
| Federal ID# (for Corp or Partnership) | ||
| SSN # (Individual, Sole Proprietor) | ||
| Product/Service Provided by Vendor | ||
| DUNN # | ||
| Requested By | ||
| Executive/Center Director Approval | ||
| Approval Date | ||
| Job Corps Centers Only | BUSINESS CLASSIFICATION | |
| ____SMALL BUSINESS (1) | ____WOMEN-OWNED (7) | |
| ____LARGE BUSINESS (2) | ____SMALL-DISADVANTAGED (8) | |
| Please check all classifications that | ____GOVERNMENT (3) | ____VETERAN-OWNED (9) |
| pertain to the vendor. | ____HUBZONE (4) | ____DISABLED VETERAN-OWNED (10) |
| ____HIST BLACK COLLEGE/UNIV (5) | ____ALASKA NATIVE BUSINESS (11) | |
| ____OTHER (6) | ||
| SIGNATURE: | ||
| VENDOR PAYMENT TERM CATEGORIES | ||
| Client Payroll / Allowance (Net 0) - for consumers wage payments and consumer allowances. Includes residential living allowances and standard weekly allowances | ||
| Consultants / Contractors (Net 30) - for professional service consultants (nursing, doctors, speech therapy, behavioral consultants, etc) and contractors (maintenance and repairs) | ||
| Direct Care Providers (Net 0) - for direct care contractors (respite, stipends, home based, etc) | ||
| Dues / Seminars (Net 7) - for membership dues and seminar registrations (Skill Path, INARF, etc) | ||
| Employees / Students (Net 7)- all employee travel and expense reimbursements and youth service division student payments | ||
| Petty Cash & Accts Rec (Net 0)- for petty cash reimbursements and payments coded to accounts receivable accounts | ||
| Postage (Net 7) - for postage and overnight payments (Pitney Bowes, US Postmaster, UPS, etc) | ||
| Rent / Lease (Net 0) - for rent and lease payments (property leases, equipment rental, etc) | ||
| Taxes (Net 0)- for all tax payments (property, real estate) excluding payroll taxes | ||
| Utilities / Communications (Net 0)- for all utility suppliers (electric, gas, water/sewer, cable, phone) | ||
| Default (Net 35) - remaining vendors not in categories above. Includes supplies, groceries, legal fees, and labor/employment agencies |
File details come from the government source that posted it. Updated .