Vendor Intake Form — Harper Mechanical Inc.

About your company

Basic information about your business.

Legal company name *

The name on your tax forms.

DBA / trade name (if different)

Federal Tax ID (EIN) *

9 digits, formatted like 12-3456789.

Business type

Years in business

Website (optional)

Company address

Street address *

City *

State *

ZIP code *

Primary contact

The person we should reach out to about purchase orders and general questions.

Name *

Title

Email *

Phone *

Accounts receivable contact (optional)

Where should we send invoice questions and remittances? Leave blank if same as above.

Email for invoices/payments

Phone

What products or services do you provide? *

A short description in your own words is fine.

Upload your documents

Upload each file below. PDF, JPG, PNG, or Word — up to 8 MB per file. If you don't have something handy, you can email it to arichards@harpermech.net later.

W-9 *Upload FilePDF, JPG, or PNG

Certificate of Insurance (COI) *Upload FilePDF, JPG, or PNG

Rate sheet Upload FilePDF, JPG, or PNG

ACH authorization form Upload FilePDF, JPG, or PNG

Business license Upload FilePDF, JPG, or PNG

Safety program / EMR letter Upload FilePDF, JPG, or PNG

Payment by direct deposit (optional)

Set up ACH so we can pay you faster and more securely. Prefer paper checks? Just skip this section.

Bank name

Name on the account

Routing number

9 digits — found on the bottom left of a check.

Account number

Usually 8–12 digits.

Account type

I authorize Harper Mechanical Inc. to deposit payments into the account above. This stays in effect until I cancel it in writing.

What else do you offer? (optional)

Check any that apply.

Anything else we should know? (optional)

Terms & conditions

Please read and check the box below.

Harper Mechanical Inc. Standard Vendor Terms

Vendor agrees to supply materials and services in accordance with Harper Mechanical's issued purchase orders. All shipments must include the matching PO number. Vendor warrants that all goods conform to specifications and are free from defects. Harper Mechanical reserves the right to reject non-conforming materials.

Vendor shall maintain insurance meeting Harper Mechanical's minimum requirements and name Harper Mechanical Inc. as additional insured. Payment terms are Net 30 from receipt of a valid invoice. Vendor agrees to indemnify and hold harmless Harper Mechanical, its officers, and employees from any claims arising from vendor's work.

Confidential information exchanged during the course of business remains the property of Harper Mechanical. Full terms provided upon issuance of purchase order.

I have read and accept Harper Mechanical's Vendor Terms & Conditions. *

How to send invoices

Follow these simple rules so we can pay you on time.

Include our purchase order (PO) number on every invoice.
Email invoices as PDFs to arichards@harpermech.net.
List each item with quantity, unit price, and any tax.
Freight or delivery charges must be pre-approved on the PO.
We pay Net 30 from the day we receive a correct invoice.

I've read the invoicing rules and will follow them. *

Sign and certify

An authorized person from your company confirms the information above.

Your name *

Your title *

Signature (type your full name) *

Typing your name here counts as your electronic signature.

Today's date *

I certify the information above is accurate and complete to the best of my knowledge. *

Office use only

Harper Mechanical staff will fill this in — you can skip it.

Vendor ID

Approved by

Approval date

Payment terms

Internal notes

Become a vendor.