Vendor Activation Form

Mersino Requestor Name *

Mersino Requestor Email *

Mersino Branch *

Date

Branch Manager Approved *

Yes

No

Branch Manager must approve new vendor activations prior to submitting this form

Branch Manager Email *

Vendor Name *

Vendor Type *

Explanation of why the vendor activation is being initiated *

Vendor Main Address *

Vendor Remit To Address (where payment is sent) *

Vendor Primary Contact *

Vendor Primary Contact Title

Vendor Primary Contact Email

Vendor Primary Contact Phone Number

Vendor AR Contact *

Vendor AR Title *

Vendor AR Email *

Vendor AR Phone Number *

Payment Terms *

Standard payment terms are Net 60

Currency *

USD

CAD

ACH Form *

ACH is required - banking information must be on company or banking affiliate letterhead for verification

ACH Remit Email *

Tax Country *

USA

Other

W9 *

A signed W9 is required from all US vendors; this includes individuals that are supplying their Social Security number as the EIN

Tax Identification Number *

Taxpayer ID

1099 Code

Taxpayer ID (XX-XXXXXXX) *

1099 Code *

Is COI Required? *

Yes

No

COI is required when the vendor is performing work on Mersino property or jobsites or will be taking possession of a Mersino asset

COI *

Is NDA Required? *

Yes

No

NDA is required when prints or proprietary information may be disclosed to a vendor

NDA *

Is a Vendor Credit Application Required? *

Yes

No

Vendor Credit Application *

Upload vendor's credit application if Mersino is required to complete. Purchasing will complete and send to vendor

Estimated monthly spend with Vendor *

Additional Forms

Mersino Vendor Intake Form, Vendor Quotes, Etc

Type of Business *

Manufacturing, Services, etc.

How many years has the company been operational?

What was vendors revenue/sales last year?

Total number of employees

Quality Management System?

Yes

No

Is vendor ISO 9001:2015 certified?

Yes

No

Is Vendor recognized as a diverse supplier?

Small Business Enterprise (SBE)

Minority-Owned Business Enterprise (MBE)

Women-Owned Business Enterprise (WBE)

Other