PCI Vendor Removal Request
Thank you for providing your services as an Active Vendor for Pacific Charter Institute: Heritage Peak Charter School, Rio Valley Charter School, Valley View Charter Prep, and Sutter Peak Charter Academy. Please complete this form if you wish to be removed from the PCI Active Vendor List.
Current Active Vendor Name
Name listed on the Active Vendor List.
A copy of this request will be sent to this e-mail.
Reason for Removal
This hereby ends the agreement for professional services entered on the day of the initial application request, by and between Pacific Charter Institute (PCI) as well as its entities and the person(s) described on this form, hereinafter described as contractors, who are NOT employees of PCI or its entities, and hold(s) PCI and its entities harmless from claims under workers’ compensation laws. Contractors have requested to be removed as an Active Vendor effective on the date of submission of this form. Contractors agree to reapply as an Active Vendor to meet the requirements set at the time of the new application in order to be considered for reinstatement. Should contractors reapply, the date of approval will be the date the newly submitted application is approved.
By typing your name in the box below, you are signing in acknowledgement that the information provided in this request is true and correct, that you have read and understand the disclosure listed in this form, that you are requesting to be dismissed as an Active Vendor with Pacific Charter Institute.