New Vendor Payee Setup Request Form

New Vendor Payee Setup Request Form

Date

County Department*

Select

Department Contact*

Company Name*

Address*

City*

State*

Select

Zip*

Contact Person*

Phone Number*

Phone

Email*

Brief Description of Service or Commodity

Please attach the required forms and check the boxes below once they are attached:

Attach the required documents here and confirm attachment below.*

Drag and drop files here or

Check this box once New Vendor Payee App attached*

Click here for the Vendor Application

Check this box if you have attached your ACH Form*

Click here for the ACH Form

Check this box if you have attached your W9 or W8*

Access the IRS form search here for the latest version: IRS Forms, Instructions and Publications

Voided Check or Bank Letter attached?*

Please attach a picture or PDF of the voided check or bank letter.

Local Business Tax attached?

If applicable. Individuals or business entities choosing to start a business, or who have an established business from another county, will need to obtain a Business Tax Account prior to doing business in Lee County. Please visit https://leetc.com/businesses/business-tax-guide-and-applications/ for additional information.

Check this box if you have attached your Certificate of Insurance*

Please ensure Lee County is listed as additional insured on the general liability. Please visit https://www.leegov.com/procurement/Documents/COI%20Requirements.pdf for Lee County's minimum insurance requirements and a sample Certificate of Insurance.

Please enter any additional comments below.

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