Vendor Application

1-701-775-8480

 


Please fill out and print the form below, and either fax to: 701-775-8479, or mail it to:
ICS, Inc.
PO Box 13158
Grand Forks, ND 58208-3158

Application Type  New Vendor  Reactivate Vendor  Address Change
Vendor Number
(Existing Vendors)
Vendor Type  Corporation  Government Agency  Individual/Sole Propietor
 Non-Profit  Partnership
Name
 (As it appears on checks; No Abbreviations.)
Doing Business As
 (If different than name on check.)

Business Classification  DBE  SBE HubZone  WBE 8a MBE VBE

SDVBE NABE

Check Below that Applies:

01- General Requirements 02 - Sitework 03 - Concrete 04 - Masonry

05 - Metals 06- Wood & Plastics 07 - Thermal & Moisture Protection

08 - Doors & Windows 09 - Finishes 10 - Specialities 11 - Equipment

12 - Furnishings 13- Special Construction 14 - Conveying Systems

15 - Mechanical 16 - Electrical Other:______________

(Check all that apply) *Please attach supporting documentation
Business Address
City State Zip
 Accounts Receivable Contact
Phone Number
Fax Number
E-Mail Address
Send Payments To (If different from Business Address)
City State Zip
Phone Number
Fax Number
Owner of the Tax Payer Identification Number (TIN or SSN)
Name
Social Security Number
Federal TIN
If you would like to enroll in EFT please complete the following fields
 Financial Institution
Routing Number
Account Number
Enter Your Name
Enter the Date
Under penalties of perjury, I certify that the number shown on this form is my correct taxpayer identification number or I am waiting for a number to be issued.

Please fill out completely. An incomplete form will create a delay in our payment(s) to you and your payment(s) could be subject to the IRS required back-up withholding.