2018-2019: Administrative Vendor Application
Thank you for your interest in becoming a vendor for Pacific Charter Institute: Heritage Peak Charter School, Rio Valley Charter School, Valley View Charter Prep, and Sutter Peak Charter Academy. Please complete all sections of this request form for consideration to become an Active Vendor with PCI.
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Vendor Information
2
Statement of Compliance Questionnaire
3
Service Information
4
Insurance Liability Questionnaire
5
PCI Invoice Requirements & Active Vendor Protocols
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Agreement & Acknowledgement
1
Vendor Information
2
Statement of Compliance Questionnaire
3
Service Information
4
Insurance Liability Questionnaire
5
PCI Invoice Requirements & Active Vendor Protocols
6
Agreement & Acknowledgement
  • Business Information

  • The Business Name will be used as the listing on the Active Vendor List upon application approval.
  • This will be listed on the Active Vendor List upon application approval.
  • This will be listed on the Active Vendor List upon application approval.
  • COUNTY the business is located. This will be listed on the Active Vendor List upon application approval.
  • - -
    This will be listed on the Active Vendor List upon application approval.
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    This will be listed on the Active Vendor List upon application approval.
  • This will be listed on the Active Vendor List upon application approval.
  • This will be listed on the Active Vendor List upon application approval.
  • Owner/Manager Information

    Complete this section if different from Business Information.
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  • Payment Information

  • Click on Browse to locate and attach a copy of your W-9 in order to issue payment on future invoice submissions should this application to become an Active Vendor is approved.
  • Pay to the order of must match the information provided on the W-9.
  • Complete if different from Business Address.
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