Approved Vendor List

Vendor Signup

Every vendor must complete this form. Remember to attach your W9 & have your agent email your insurance certificate, to the email listed below.

* Indicates required field

Company Name *

Vendor Industry *

If Other please explain *

Payment Remittance Address *

Line 1

Line 2

City

State

Zip Code

Country

Company Structure *

Corporation Sole Proprietor Partnership

Primary Contact Name *

First

Last

Phone Number *

Email *

Accounts Receivable Contact *

First

Last

Phone Number *

Email *

W9 File *

Max file size: 20MB

Association Annual Contract Agreement *

Max file size: 20MB

We pay our vendors through echeck, this eliminates the time it takes for the mail to loose your check. By signing up you will receive your check directly into your account, you will be paid several days earlier and there is no opportunity for a check to be lost in the mail system. You will also receive a detailed email of the payment at the same time that we pay you. Signing up for echeck saves our office & your office processing time.

Routing Number *

Account Number *

This account is *

Checking Savings

Certificate of Insurance Requirements: We can not accept your certificate of insurance directly from your office. We must receive it from your agent. Please contact your agent and ask them to name Executive Management Group as additional insured and send that COI to [email protected]

Submit

Please note: the form will disapear and you will receive a confirmation page if the form was submitted accuratly. If you do not see the confirmation page then something in the form needs to be corrected.