Vendor Request - Lyon Shipyard

Vendor Name
Business Name
- Individual/sole proprietor or Single-member LLC
- C Corporation
- S Corporation
- Partnership
- Trust/Estate
Please choose one
- Tax ID Number
- Social Security Number
Tax ID
Social Security Number
Please upload a copy of W-9*
If Sales tax exempt, please attach copy of certificate (only if applicable)
Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Remittance Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Accounts Receivable Contact Name
Accounts Receivable Contact Phone
Accounts Receivable Contact Fax
Accounts Receivable Contact Email
Person requesting new vendor
Phone
Date
Date Format: MM slash DD slash YYYY