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Get Delphi Vendor Entry Worksheet 2006-2024

Revised May 2006 Delphi Vendor Entry Worksheet Bold/Yellow indicates required fields NAME E-MAIL ADDRESS PHONE DATE New SUPPLIER NAME TAXPAYER ID DUNS or DUNS 4 NO. No Cost Lease/Award Vendor Modifying Federal Agency CLASSIFICATION/TYPE FEDERAL AGENCY LOCATION CODE ALC GENERAL Parent Supplier Name Tax ID Number For New Agencies Corporation Government Agency Individual Partnership Foreign Corp / Govt Agency / Indiv / Partner Reimbursable Non-Govt Supplier/Grant Sponsor/State Local Govt ORGANIZATION TYPE CCR VENDOR IS REGISTERED Yes No SUPPLIER SITES Additional sites or additional Tax Reporting Address forward as attachment Supplier Number Country United States Address Adding Site Supplier Site Name Other City County PAYMENT State Zip Code Payment Method SITE USES AND TELEPHONE Pay Site Purchasing Site Voice Area Code Number Fax Area Code Number Electronic Check Waiver Required Primary - Note Provide this information only if obtained at Contract award. SUPPLIER CONTACTS 1. Last Name Title First BANK MI Telephone Checking Bank Name Account Name Bank ABA Routing No Account Type Savings EFT Form Fax to AMZ 405-954-6944. No Cost Lease/Award Vendor Modifying Federal Agency CLASSIFICATION/TYPE FEDERAL AGENCY LOCATION CODE ALC GENERAL Parent Supplier Name Tax ID Number For New Agencies Corporation Government Agency Individual Partnership Foreign Corp / Govt Agency / Indiv / Partner Reimbursable Non-Govt Supplier/Grant Sponsor/State Local Govt ORGANIZATION TYPE CCR VENDOR IS REGISTERED Yes No SUPPLIER SITES Additional sites or additional Tax Reporting Address forward as attachment Supplier Number Country United States Address Adding Site Supplier Site Name Other City County PAYMENT State Zip Code Payment Method SITE USES AND TELEPHONE Pay Site Purchasing Site Voice Area Code Number Fax Area Code Number Electronic Check Waiver Required Primary - Note Provide this information only if obtained at Contract award. SUPPLIER CONTACTS 1. Last Name Title First BANK MI Telephone Checking Bank Name Account Name Bank ABA Routing No Account Type Savings EFT Form Fax to AMZ 405-954-6944. .

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