New Vendor / Change Form

WEST KNOX UTILITY DISTRICT
New Vendor /Change Form

Tax ID Number : *

Company Name : *

Mailing Address : *

City : *

State : *

Zip Code : *

Primary E-Mail : *

E-Mail Confirmation *

Contact Name : *

Contact Title : *

Phone Number : *

Please Upload W-9 Form Here : *

Additional Documents :

How do you want to receive your payment? *

Remittance E-Mail : *

Secondary Remittance E-Mail :

Name Of Bank *

Routing Number : *

Account Number : *

I hereby certify that, to the best of my knowledge, the provided information is true and accurate. Further, I attest I am an authorized business representative to sign on behalf of the company listed above.

Signature : *

clear

Print Name : *

Date : * +