Select State

What state is your account in?
Indiana
Ohio
 
 

Select State

What state is your account in?
Indiana
Ohio

Vendor Profile Form


Please answer all sections and attach a completed W-9 form. (Please add all attachments at the bottom of this 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.
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