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New Vendor Setup Form

2. Date
   Date

4. Vendor Name*

6. Remit to Address:

8. City

9. State

10. Zip Code

12. Phone Number

13. Fax Number

15. Email Address

17. A/R Contact Name

19. W-9
    Blank W-9

    Please email associated W-9 to Accounts Payable. mhooper@co.coffee.al.us

20. 1099 Vendor?

    1. Yes
    2. No

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field