New Customer / Vendor Set-Up Form

Date

Business Name *

If you have an account already, enter an Invoice Number, Account Number, Site Number or Contact Number. If not, enter your name along with your VASEY Contact Person.

Are You Doing Business Under Another Name? Do You Have a DBA (Doing Business As)?

Customer Type *

New
Existing
Previous

Do You Require a W-9 Form? *

Yes
No

Do You Require a Certificate of Insurance (COI)? *

Yes
No

If YES to COI, state any requirements.

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Work Site Address *

Address Line 1

Address Line 2

City

State

Zip Code

Work Site Contact Name *

Work Site Contact Telephone Number *

Work Site Contact Email Address *

Do You Require a Purchase Order (PO) or Work Order (WO) Number? *

Yes
No
Other

If Other, Explain...

Accounts Payable Telephone *

Accounts Payable Contact Name *

Accounts Payable Email Address *

Do You Prefer Invoices to be Emailed? *

Yes
No

Do You Prefer Statements to be Emailed? *

Yes
No

How Will You Submit Payment? *

Credit Card
ACH
Check

Are You Tax Exempt? If Yes, please PDF and attach your Tax-Exempt Form *

Yes
No

For questions, please email AR@VASEY.com. For your protection, this information IS NOT ARCHIVED on the website or anywhere on the Internet. Please submit a FULLY COMPLETED FORM or your data will be lost.

Please complete the following online form (below) OR complete the PDF and send to VASEY Office (*Required)