Updated JSL 01/23/19

Vendor Registration Form *Tempe Union High School District No. 213

500 W. Guadalupe Rd. Tempe, AZ 85283

Phone: (480) 345-3734 or (480) 345-3796 Fax: (480) 345-3441

Are you or a family member a district employee? No Yes

Date:

If yes, please refer to *District policy G-0700 and *Conflict of Interest Disclosure Form. Are you a Student? No Yes Reimbursement/Refunds.

Will the vendor/employees be in the presence of students on District property? No Yes If yes, a *D.P.S. Fingerprint Clearance Card for each individual is required.

Services/Products Provided:

All requests to add vendors shall come through Tempe Union High School Distract staff; name & address must match W9 form.

Person/Department you are working with at TUHSD:

P.O. Issued to: Payment Remittance: Needs to match W9 Business Name (D.B.A.) Legal Business Name

Address Address for Payments

Address Address for Payments

City State Zip Code City State Zip Code

Contact Name Payment Contact Name

Order Email (where P.O. will be e-mailed) Payment Contact Email

Contact Phone Number Payment Contact Phone Number

Contract? No Yes Mohave State Cooperative If Yes, Contract Number _____________________________

The District must have a valid *W-9 and *Certificate of Insurance on file; you will not be registered

without a copy on file. Note: All Purchase Orders are subject to the *Tempe Union High School District's terms and conditions.

TUHSD Purcha

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