New Vendor Add Request Form

To be Completed by The Department Requesting - One Vendor Per Request Form

Vendor Name

Vendor Type

Date of Department Request

Department

Club

Requested by (employee name)

Requestor email address

Requestor Signature

Authorizer (employee name)

Authorizer Signature (separate to requestor)

To Be Completed by the Vendor or the Requesting Department

Vendor Official Company Name for account *

Canadian or USA vendor *

Vendor Physical Street Address *

City *

Province/State *

Postal/Zip *

Purchase Order delivery method? (email unless otherwise specified)

Email/Fax Number to send Purchase Orders *

Primary Accounting Contact *

Accounting Contact Phone Number & Ext.

Product and/or Service Provided by Vendor *

Company Name that appears on invoices (if different from above)

Remit to Address Same as address above?

Remit To:

City

Province/State

Postal/Zip

Federal GST Number

Payment Terms (if other than Net 30 Days)

Account/Customer Number assigned to Club

Payment method

Additional information:

By completing and submitting this form you agree that your banking information will be used by The Glencoe Club or The Glencoe Golf & Country Club for the purpose of automatically depositing Canadian dollar invoice payments directly to your Canadian dollar account.
Remittance statements will be emailed to you from ap@glencoe.org or golfap@glencoe.org. Please ensure this email address is added to your list of contacts or save centres

Supplier Bank Information

To receive payment issued by The Glencoe Club, complete the following information and attach a void personalized cheque or direct deposit form issued by your recognized Canadian financial institution. Note that forms submitted without a void cheque or equivelent will not be accepted.

Name of Bank

Bank Contact

Bank Contact Email

Bank Phone Number *

Bank Address *

Institution # *

Bank/Transit # *

Account # *

Void personalized cheque or bank verification attached? *

Please notify us by email of any updates to your banking information.

As part of our commitment to ethical business practices and compliance with corporate governance standards, we require all new vendors to disclose any relationships that may constitute a Related Party Transaction.

Please review the statement below and complete the attestation.

DECLARATION:
I hereby declare that:

There are no known relationships (personal, familial, financial, or otherwise) between the vendor (including its employees, officers, directors, or owners) and any employee, officer, director, or agent of The Glencoe Club or The Glencoe Golf & Country Club.

No senior employees or officers of the company are members of The Glencoe Club or The Glencoe Golf & Country Club.

There is a relationship as described below:

(Please describe the nature of the relationship, including the names of the individuals involved and the nature of the relationship.)

ATTESTATION:

I certify that the information provided in this form is true and complete to the best of my knowledge. I understand that the provision of incorrect information or failure to disclose related party relationships may result in disqualification or termination of any agreements.

Authorized Representative:

Title:

Signature:

Date:

The personal information on this form is collected for the purpose of electronically transferring funds to your financial institution account. The personal information collected will be used and disclosed in compliance with Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act. For further information, call 403-243-2506.

INTERNAL USE ONLY:

Vendor information entered by:

Signature:

Date:

Vendor information verified by:

Signature:

Date:

Glencoe Vendor Number Assigned:

Vendor must provide account number assigned prior to payment.
Federal GST Tax ID Number: Glencoe 122274129 Golf 122274103

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New Vendor Add Request Form

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