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NEW VENDOR REQUEST FORM
Vendor Data
Vendor Name:
Vendor Remit To Address:
Vendor Phone:
Vendor Fax:
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Dun & Bradstreet Number:
Primary Contact
Primary Contact Name:
Primary Contact Position:
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Primary Contact Phone:
Primary Contact Fax:
Primary Contact E-mail Address:
Order E-mail Address*:
*Valid e-mail required. All purchase orders are e-mailed to this address.
Confirm fax of a Form W-9 will be faxed to 724-658-5138, Attn: IPEC Purchasing Department?
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Your IPEC Contact's Name:
Your IPEC Contact's E-mail:
IPEC's standard e-mail format is first letter of first name, full last name then @ipec.com. For example, Joe Smith would be jsmith@ipec.com
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