Indiahoma Public Schools Vendor Registration Form

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New Vendor and Vendor Renewal/Update Application

Email *

Application Type *

New Application

Renewal/Update Application

Required

Oklahoma Teachers Retirement System (OTRS) Status (Applicant must select one of the following options) *

Retired from OTRS & actively drawing a pension check

Retired from OTRS but have suspended drawing a pension check & wish to stop my retirement & return to active membership status.

Not retired from OTRS

Required

Company / Individual Name *

First and last name

Federal Tax ID or Social Security Number *

Address / City / State / Zip *

Remit to Address / City / State / Zip (if different than the one above) *

Email *

Phone number *

Type of Business – Products(s) Sold / Services Provided *

Are you related to an Indiahoma Employee or Board Member? If yes please provide their name/names. *

*Read and Sign* (A completed W-9 form must be submitted with this application. See W-9 link and submittal instructions below.)

Signature *

Date *

YYYY

Click for W9 Form (please email completed W9 to nickie.obrien@indiahomaps.org)

Please Call 580-246-3448 ext 3 to verify your application has been received. *

I understand

Required

Send me a copy of my responses.

Submit

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