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Vendor Application

Vendor Application

VENDOR REGISTRATION FORM

TO BE COMPLETED BY NEW VENDORS/SUPPLIERS ONLY. This form is used to obtain supplier information to ensure accurate supplier maintenance. All suppliers that are interested in doing business with REMSA Health must submit a current signed W-9/W-8BEN with the supplier’s information as reported to the IRS.

If you require further assistance, please call (775) 858-5700 or email remsaap@remsa-cf.com.

Legal name should be consistent with name on federal tax forms.
Address
Contact Name
(Data Universal Numbering System)
(Employee Identification Number)

Required Documents

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Max. file size: 200 MB.
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    Max. file size: 200 MB.
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      Max. file size: 200 MB.
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