Sub Contractor & Vendor Registration

Accounting open: 9am – 5pm

Registration Type:
Sub ContractorVendor
Company Name:
Year Company Established:
Company Type:
CorporationPartnershipSole ProprietorshipIf other, please specify type:
Address:
Phone:
Email:
Tax Identification Number (TIN):(must be 9 digits)
If Sole Proprietor (Withholding, 1099) enter your SSN in lieu of the TIN:

Work Performed By Your Company

Sitework:
FencingGeneral SiteworkPavementLandscapingBuilding DemolitionCurbs & Walks
Thermal & Moisture Protection:
RoofingSpray on FireproofingJoint SealantsMetal Wall PanelsDamproofing & WaterproofingSiding Panels
Finishes:
EIFSGypsum Drywall/CeilingsCeramic TileResilent Tile Flooring/CarpetPainting & FinishingStain Concrete
Mep:
SprinklerPlumbingHVACElectricAV Systems
Security:
Detention Equipment & SystemsSecurity Hollow Metal/HardwareSecurity Glazing/WindowsElectronic Security Systems
Concrete & Masonry:
Concrete WorkMasonry WorkPrecast Concrete
Doors & Windows:
Door Frames & HardwareRoll Up DoorsGlass & Glazing
Specialties:
Wire Mesh PartitionsWindow TreatmentsLouvers
Conveying Systems:
ElevatorsWheelchair Lifts
Metals:
Structural SteelMiscellaneous Metals
Wood & Plastics:
Architectural Woodwork
Equipment:
Kitchen Equipment
Other:

Contact Information

Sales Representative
Name:
Title:
Phone:
Email:
Account Manager
Name
Title:
Phone:
Email:

ACH Information

  Check here if your company does not have the ability to complete ACH transactions.

If you would like to set up electronic ACH payments, please complete the section below:

Name of Bank:
Branch Name and Location:
Bank's ACH Coordinator:
Bank's ACH Coordinator Phone:
Vendor Name (as it appears on account):
Branch Name / Branch ID #:
Bank Account #:
Account Type:
Transit Routing # (must be 9 digits):

Company MBE/WBE/Section 3 status

Is the company Minority Owned?

YesNo
Is the company Woman Owned?
YesNo
Does your company qualify as a Section 3 Vendor under HUD's Section 3 Act of 1968?
YesNo
For details click, HUD's Section 3 program.

Consent

By clicking here, I certify that I am authorized to supply this information and that all the information provided is true to the best of my knowledgeName:

Must include the following enclosures when returning this form to The New Modern Home.
   - A completed and signed W9 form.
   - Copies of any applicable MBE or WBE certification.