New Vendor Request Form

ATU Employee Name and ATU Department Requesting Vendor*

Requestor's ATU Email *

Requestor's Telephone Number *

Name of Company or Sole Proprietor *

DBA (Doing Business As) *

Street Address *

PO Box

City, State, Zip *

Business Telephone Number *This is needed in order to contact the vendor. Do not use N/A please.

Fax Number*

Business Email Address *This is needed to send forms to vendor. Do not use N/A please.

Reason for new number *

Place Order

Game Official

Stipend

Travel Reimbursement

Reimbursement

Invoice

Refund

Honorarium / Guest Speaker

Is this person a Tech student?*

Yes

No

Is this person a Lawyer?*

Yes

No

Is this person a Medical Professional?*

Yes

No

By submitting this request I certify that I have neither a personal financial or other stake in the requested vendor, nor a conflict of interest, and that any and all requests for payment to this vendor will be for official Arkansas Tech University business. Click to agree*

Agree