HaShems Harvest
Vendor Data Sheet & Application
GENERAL INFORMATION:
- Firm or Business Name:
- Doing Business As (DBA):
- Street Address:
4. Billing Address:
- City:
5a. State
5b. Zip:
- Telephone:
7. Fax:
- Please list all offices and/or affiliate addresses below:
8c.
- E-Mail Address:
10. Accounts Payable Contact Name:
11. Years in Business:
12. Federal Tax Number:
13. Type of Business: Sole Proprietorship Corporation Partnership Subsidiary
14. Type of work:
15. Proprietor, Partners, Officers, if incorporated:
15a. Name:
Home Address:
City:
State:
Zip Code:
SS#:
15 b. Name:
Home Address:
City:
State:
Zip Code:
SS#:
16. Year Business Established:
17. At Present Location Since?
18. List employee(s) names and titles that can sign contracts and/or authorize purchase orders/work orders on behalf of your company:
2.
3.
19. Are you accredited by the Dunn & Bradstreet and/or the Better Business Bureau? Yes / No
CREDIT REFERENCES: (Please provide three)
Company Name:
Mailing Address:
Telephone Number:
Fax Number:
Contact Person:
Title:
E-Mail Address:
How Long Have You Been Doing Business With This Company?
CREDIT REFERENCES: (Please provide three)
- Company Name:
Mailing Address:
Telephone Number:
Fax Number:
Contact Person:
Title:
E-Mail Address:
How Long Have You Been Doing Business With This Company?
CREDIT REFERENCES: (Please provide three)
- Company Name:
Mailing Address:
Telephone Number:
Fax Number:
Contact Person:
Title:
E-Mail Address:
How Long Have You Been Doing Business With This Company?
AUTHORIZATION FOR RELEASE OF INFORMATION:
I hereby warrant that the above information is true and correct, and is furnished for the purpose of establishing a vendor relationship with Hashems Harvest. I hereby agree that Hashems Harvest may investigate my record and that, if approved, Hashems Harvest may furnish this authorization to secure the information they need to establish a business relationship.
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Name Title