vendor questionnaire

VMI - VENDOR MASTER INFORMATION
DATE:
REQUIRED FIELDS ARE DENOTED BY *
✔
NEW VENDOR
CO. CODE:
INVOICE
VENDOR QUESTIONNAIRE
*
ADOBE INTERNAL USE ONLY
Clear Form
REQUISITION
CONTRACT
CONTRACT NO.
DATA CHANGE VENDOR #
APPROVER:
COMPANY INFORMATION
*COMPANY NAME: AccessibilitéWeb (a11yMTL)
REMIT TO :
(IF DIFFERENT)
*STREET: 1751 Richardson street suite 6111
ADDRESS:
(NO PO BOX)
*CITY: Montréal
*STATE: Québec
*COUNTRY: Canada
CITY:
*POSTAL CODE: H3K 1G6
STATE:
COUNTRY:
POSTAL CODE:
*CONTACT NAME: Denis Boudreau
*EMAIL: [email protected]
*PHONE: 1 877 315 5550
FAX:
1 877 315 5550
UNSPSC #
DUNS #
SIC CODE
US VENDORS MUST COMPLETE EIN:
THIS SECTION. A SIGNED W-9
SSN:
FORM MUST BE SUBMITTED
BANK INFORMATION
Woman-owned
Small Business
Minority-owned
Disabled Veteran
** SORT CODE AND SWIFT CODE ARE REQUIRED IF LOCATED OUTSIDE OF USA
*BANK NAME: La Caisse d’Économie Solidaire Desjardins
BANK ADDRESS:
*CITY: Montreal
155, Boul. Charest Est Bureau 500
BANK BRANCH (IF APPLICABLE):
STATE:
Desjardins
**NON-U.S. BANK # (SORT CODE):
Quebec
*COUNTRY: Canada
815-92276
**SWIFT/BIC CODE:
CCDQCAMM
U.S. BANKS ONLY - ABA #:
CANADA ONLY - BANK TRANSIT ROUTING #:
*BANK ACCOUNT #: 0815 92276 564550 2
IBAN:
815-92276
ACCOUNT NAME (IF OTHER THAN COMPANY NAME):
ADDITIONAL NOTES:
DESCRIBE YOUR CORE LINE OF BUSINESS:
DO YOU ACCEPT CREDIT CARDS?
Web Accessibility expertise - training, consulting, events, etc.
Yes
✔
No
IF YES, WHAT IS THE ACCEPTED LIMIT?
ADOBE INTERNAL USE ONLY
PAYMENT TERMS:
Select one...
PAYMENT METHOD:
Select one...
CURRENCY:
SELECT ONE...
INDUSTRY:
SELECT ONE...
FOR NEW USA VENDORS, A COMPLETED W-9 FORM IS REQUIRED
THE W-9 FORM MUST BE AN OCT. 2007 VERSION OR LATER
Rev. date 12.02.09