Vendor Information Form

BCFS Health and Human Services will be transitioning to a new procurement system in September 2024.

Please fill out the form below so we can set you up as a vendor in our new system.

Please reach out with any questions or concerns to AccountsPayable@BCFS.net.

*If we have more than one account active with your company, please complete a form for each account.

Business Name

Address Line 2

Address Line 1

City

State

Postal Code

Country

Primary Contact (Sales/Billing Contact)

First

Last

Phone Number

Fax Number

Website

Tax ID Number

Reference Number used in Vendor's System (Account or Customer Number)

Name

First

Last

Job Title

Business Phone Number

Cell Phone Number

1099 Vendor

Yes

1099 Box MISC01 - Rents

Yes

1099 NEC01 - nonemployee Compensation

Yes

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