Get Alliance Vendor Profile Form (short Form)

The Alliance Vendor Profile Form (Short Form) is essential for vendors to provide necessary business information for partnership with Alliance Health. This guide offers clear instructions on completing the form online, ensuring that all required sections are filled accurately.

Follow the steps to complete the Alliance Vendor Profile Form online.

1. Press the 'Get Form' button to access the Alliance Vendor Profile Form and open it in your browser.
2. Enter your legal name as registered with the Secretary of State in the designated field.
3. Provide your 'Doing Business As' name, if applicable, to reflect the name under which you operate your business.
4. Fill in your full mailing address, ensuring that all fields are adequately completed for correspondence purposes.
5. If your remit address differs from the mailing address, please fill it in the allocated space.
6. Include your website URL and contact telephone number for easier communication.
7. Input your Federal Tax ID number accurately, as it will be used for verification purposes.
8. Indicate whether you require a 1099 form by selecting yes or no.
9. Check the applicable boxes under Business Type to identify your business structure.
10. Provide your contact information by filling out your name, title, email address, signing, and dating the form.
11. After reviewing all provided information, save changes, and download or print your completed form for submission. You can also share it if necessary.
12. To submit the form, either click the submission button or scan and email the completed document to GPSetupRequests@alliancebhc.org.

Complete your Alliance Vendor Profile Form online today to ensure a smooth partnership with Alliance Health.