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Vendor Registration

  1. Contact the Finance Department

    P.O. Drawer 400
    2671 San Angelo
    Ingleside, TX 78362

    Phone: 361-776-2517
    Email the Finance Department

  2. Vendor
  3. As shown on income tax return & field 1 of W9

  4. If different from fields 5&6 on W9

  5. You must furnish a copy of the following items to the Finance Department for your registration to be completed
  6. Checks will be made out to the name listed in field 1 of the W-9. DBA listed in field 2 of W-9 will be shown below. Checks will be mailed to the address listed in field 5 & 6 on W-9, unless a separate remittance address is listed on this form. Form-1099 will be mailed to the address listed in the W-9 without exception.

  7. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  8. Office Use Only
  9. Leave This Blank:

  10. This field is not part of the form submission.