Vendor Qualification Form

Vendor Qualification Form
Eagle Mountain Staff Contact:*
Please list name of contact you're working with at the city.
EMC Staff Contact Email*
example@emcity.org
Legal Company Name:*
Years in Business*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Organization Type:*

IndividualCorporationPartnership
Entity / State Business License Number*
State of Utah issued number.
Principal Product/Service:*
Number of Employees*
Do you or anyone in your company have a personal or family relationship with any Eagle Mountain City employee?*

YesNo
Please Describe:*
Are any of your products/services on the Utah State Cooperative Purchase Contract?*

YesNo
Please list the contract numbers:*
We are a participating employer with the Utah Retirement Systems (URS). Are you receiving a retirement pension from URS?*

YesNo

Please attach your W-9 or W-8 (Foreign Entities)*

PDF formatting only
Cancelof
Will work or services be performed on Eagle Mountain City property?*

YesNo
Please upload a certificate of liability insurance*

Please ensure Description of Operations and Certificate Holder fields have Eagle Mountain City identified.
Cancelof

Eagle Mountain Purchasing Guidelines
- Eagle Mountain City requires a purchase order.
- Payment terms are always net 30.
- Please e-mail invoices to ap@eaglemountain.gov
- No payments for service will be made without a W9 or W8 on file.
I have read and agree to adhere to Eagle Mountain City's purchasing guidelines

Clear
Printed Name*
Title*
ACH Direct Deposit Authorization

The company named above (“Company”) herby authorizes and request Eagle Mountain City to make electronic payments to the financial institution named in this form. Company Authorizes Eagle Mountain City to retract or correct any amounts deposited into Company’s account in error. Eagle Mountain City will notify the Company prior to any retraction or corrections of deposited amounts. The company will reimburse Eagle Mountain City in full upon demand any incorrect deposits into the Company’s account which are not recovered by Eagle Mountain City. In the event the Company changes its banking instructions or closes the account, the Company agrees to notify Eagle Mountain City immediately. The company understands that the actual deposits of the funds to the Company’s account will be the responsibility of the financial institution.
Should be Empty:

Payment Information