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Pace University Vendor Request

Pace Requestor's Name: *
Pace Requestor's Email: *
Pace Requestor's Phone: *
Pace Request Date: *
Federal ID# / SSN#: *
Corporation / Company Name: *
Company Type:  * Alumni Owned Employee Owned Minority Owned Small Business State
Contract Dealer Individual Manufacturer Retailer Partnership Incorporated
Other
PO Delivery Preference:  * By Fax By Email
1099 Vendor? * Yes No
                          Type of Services or Commodity:  *
Does your company participate in E-Procurement?  * Yes No

If YES, enter e-procurement contact information:

                                                 E-procurement Name:
Email Address:
Telephone Number: Area Code:       Phone:       Ext:  

Primary Contact:

                                                                       Name: *
Email Address:
Telephone Number: Area Code: *     Phone: *      Ext:  
 
Business / Primary Address: BU (Business Address) PR (Primary Residence)

(PO Box numbers are not acceptable for address, must submit physical street address. PO Box numbers can be used for remittance address.)

 
                                                              Address1: *
Address2:
Address3:
City: *
State: *
Zip Code: *
Country: *
Telephone Number: Area Code: *      Phone: *      Ext:  
Fax: Area Code: *          Fax: *     

Corporate Headquarters:

                                                                   Address1:
Address2:
Address3:
City:
State:
Zip Code:
Country:
Telephone Number: Area Code:       Phone:       Ext:  
Fax: Area Code:       Fax:          

Remittance Address: (Payments will be forwarded to this address, please fill in all the required fields)
 

                                                              Address1: *
Address2:
Address3:
City: *
State: *
Zip Code: *
Country: *
Telephone Number: Area Code: *      Phone: *      Ext:  
Fax: Area Code: *          Fax: *     

Mailing Address:

                                                               Address1: *
Address2:
Address3:
City: *
State: *
Zip Code: *
Country: *
Telephone Number: Area Code: *      Phone: *      Ext:  
Fax: Area Code: *          Fax: *     

Electronic Funds Information:

                                                              Bank Name:
ABA/Routing Number:
Bank Account Number:
Account Type: Savings          Checking
Bank Address1:
Address2:
City:
State:
Zip Code:
 

                                                              Comments:



If you have any questions you can contact the Purchasing office at (914)923-2621 or email at Purchasing@pace.edu