New Vendor Request Form

Supplier's Name*

(Enter the full legal name of the supplier)

Requested By:*

(Supplier Employee Name)

Which are you?

Indicate if the request is for establishment of a new supplier or reactivation of a past supplier. (W9 & Certificate of Insurance Required)

New Supplier
Reactivation

ACBL Sponsor / Contact*

(if none, please state accordingly)

Please describe any previous or current relationship that you have with ACBL or ACBL employees

(i.e. existing Personal or Family relationships, Previously Approved Vendor, etc.)

Please describe the parts and services that your company provides*

Supplier Category*

Indicate the purpose of the request*

If the vendor is providing port services the requestor should include a description of the specific services being provided (shifting, fleeting, towing, etc.) along with a copy of the applicable rate sheet(s).

Supplier Ordering Address

Enter the supplier name, address and contact information for both ordering and billing remittance

Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name*

First Last

Phone*

Fax

Email*

"Remit To" Same as "Supplier"?*

Yes
No

Remit To Address:

(If Different than Supplier Ordering Address)

Name*

Contact Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Email*

Supplier Terms and Conditions

Terms and Conditions acknowledgement not applicable to Fleeting, Shifting, and Towing Vendors, or any vendor with an active MSA

Link to Terms and Conditions

I have read and agree to the applicable ACBL Standard Terms and Conditions*

Yes

Documentation

Upload Rate Sheet

(Port Services Vendors)

Upload Insurance Certificate*

Upload W9*

(or Equivalent)

Additional Document(s)

Drop files here or

Description of Additional Document(s)

Suppliers

Navigate

Navigate

Request to Become a Vendor

Supplier Ordering Address

Remit To Address:

Supplier Terms and Conditions

Documentation

Next Page