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	Vendor Profile Form Please answer all section and complete attached W-9 form. (* indicates required fields)

1. Company Information

Full Legal Name*:

DBA Name (if applicable):

Type of Company*:

Supplier Contractor Consultant Other

Phone*:

Address*:

City*:

State*:

Zip*:

Taxpayer ID*:

2. Purchasing Information (for PO's and RFQ's)

Contact:

Title:

Address:

City:

State:

Zip:

Primary Phone:

Fax:

Cell:

Email*:

Preferred Notification Method:

Payment Terms:

Services Rendered:

Materials Services Materials and Services Other

3. Accounts Receivable Information (for payments)

Contact:

Address:

City:

State:

Zip:

Phone*:

Fax:

Email:

Is your company 1099 tax reportable?*

Yes No If No, reason*:

If at a later date, information submitted to us on the attached W-9 has changed, then please complete and submit to us an updated W-9.

4. Bank Information for ACH (for electronic payments - recommended)

To participate in having your payments sent by ACH (Electronic Payment), please click here for more information.

NOTICE: Government regulations have changed regarding the use of direct deposit. As a result, Vectren does not offer the direct deposit of funds to either a foreign bank or a U.S. financial institution when the entire amount will be forwarded to a bank account in another country.

5. Financial Information

Years in Business:

Do you accept credit cards?:

Yes No

Annual Gross Sales (average over the last 3 years):

6. Business Statistics

# of Employees:

# of Minority Employees:

# of Female Employees in non-clerical roles:

What are your primary NAICS codes*:

1) 2) 3)
4) 5)
(See http://www.census.gov/epcd/www/naics.html to search for your NAICS code(s).)

What are your primary UNSPSC codes*:

1) 2) 3)
4) 5)
(See http://www.unspsc.org to search for your UNSPSC code(s).)

Please select your business type. Select all that apply. A copy of Certification is required (for asterisks).

Large Business Small Disadvantaged (8A)* Minority Owned* Hub Zone Veteran Owned	Small Business Women Owned Disabled Business Owner
Service Disabled Veteran Owned Small Disadvantaged Business (non-8A) (net worth does not exceed $750,000) **The net worth of each individual upon whom the certification is based does not exceed $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2).

Please note: Under 15 U.S.C. 645(d), any person who misrepresents its size status shall (1) be punished by a fine, imprisonment, or both; (2) be subject to administrative remedies; and (3) be ineligible for participation in programs conducted under the authority of the Small Business Act.

Authorized Official*

Please enter the name and title of the official that authorizes this information to be true and accurate.

Name: Title:

To attach a file, please click browse to find your file. Once the file is chosen, please click attach. A maximum of three (3) attachments is allowed.

Attachment(s):

Customers Create Online Account Manage My Account Pay Bill Billing/Payment Options eBill Find a Payment Site Understanding My Bill Moving? New Utility Customers Ohio Choice Outage Center Choose Natural Gas	Corporate Corporate Information Investor Relations Public Safety Corporate Governance Economic Development Our Policies Regulatory Information Marketing Programs Vectren Diversity News Room	Conservation Connection Residential Appliance Rebates Business Appliance Rebates New Home Construction Energy Efficiency Tips Business Custom Program Home Weatherization Online Energy Audit Analyze My Bill Request a Speaker VectrenLiveSmart.com Live Smart Newsletter Energizing Indiana	Careers Employment Opportunities Benefits Vectren Diversity Community Vectren Foundation School/Safety Programs Gift of Energy News Room

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