Vendor Form 400 Galleria Officentre, Suite 300 Southfield, MI 48034 Please send all inquiries to AP@donerpartnersnetwork.com Vendor Form Choose Agency * Choose AgencyDonerKWT GlobalYamamotoPRophetWolfgang Agency Contact / Buyer Vendor Information Legal Name * DBA If applicable Freelancer I am a freelancer Website Contact Name * Contact Title Contact Phone * Contact Email * Contact Address * Contact Address Contact Address Contact Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Please Select a Service Category * ProductionMediaFreelancerInfluencerOther Please Select a Service Category What types of services do you provide? Preferred Payment Method * ACHCheck ACH Details Routing Number * Account Number * Confirm Account Number * Payment Verification * Attach an official bank letter with ACH details Attach bank letter Maximum file size: 52.43MB Check Details Address same as above Address same as above Vendor Name * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Payment Verification Maximum file size: 52.43MB Diversity Vendor Diversity * Choose OneMinority OwnedWoman OwnedVeteran OwnedSmall BusinessHUBZoneLGBTNone of the above Ethnicity Choose EthnicityAsian-IndianAsian-PacificBlackHispanicNative AmericanCanadian AboriginalsSubcontinent AsianOther Woman Owned Ethnicity Choose EthnicityAsian-IndianAsian-PacificBlackHispanicNative AmericanCanadian AboriginalsSubcontinent AsianOther * Only required if WMBE certified A copy of all certificates is required if a diversity is selected. If you hold multiple certificates, please upload all active certificates. Self Reported Self Reported File Upload Drop a file here or click to upload Choose File Maximum file size: 52.43MB Only PDF file type accepted Confirmation * I confirm that the above information is accurate and agree to the Terms and Conditions. If you are human, leave this field blank. Submit
