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2. VENDOR INFO

4. Please provide the following information when submitting a request to open a new vendor account or when updating vendor information. Completion of this form does not guarantee business or establish a contractual relationship.

6. Business Name*
10. BILLING INFO
12. Remittance Address*

    (Where you want your payment sent)

14. Address Line 2
16. City*
17. State*
18. Zip Code*
22. Is your business address the same as your remittance address?

    1. Yes
    2. No

    If no, please complete the billing address section below.

24. Billing Address
    (Where you want your bill sent)

    
    

26. City
27. State
28. Zip Code
32. Billing Contact*
34. Billing Email*
35. Billing Phone*
37. Will you accept ACH payments?*

    1. Yes
    2. No
41. BUSINESS INFO
43. Federal Taxpayer ID (FEIN)
44. Registered State
46. Business Type*

    1. "C" Corporation
    2. "S" Corporation
    3. Limited Liability Company
    4. Partnership
    5. Other
47. Are there any personal connections with employees?*

    1. Yes
    2. No
49. Please upload supporting documentation of diverse business classification.
51. Please upload a current W9*
55. SUBMIT INFO
57. City of De Soto Contact
    -- Select One --Brad WeisenburgerBrandon MillsCameron MaughmerDale HamiltonDoug SmithJay GarvinJim BriggsMarshal GoodnightMartin JuarezMayte DiazMike BrungardtRon CreasonWhitney LangeOther
59. Submitted By*
61. Please email all invoices and statements to apayable@desotoks.us
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field