BALTIMORE COUNTY PUBLIC SCHOOLS



BALTIMORE COUNTY PUBLIC SCHOOLSVENDOR MODIFICATION FORMPlease type information on this modification form; however, if you must hand write, make it legible Vendor Number: FORMTEXT ????? Last four digits of Social Security number: FORMTEXT ???? FULL Vendor Name (currently in BCPS System): FORMTEXT ????? BCPS Employee: FORMCHECKBOX Yes FORMCHECKBOX No – If not BCPS employee, must submit Form W-9PRIOR Address: FORMTEXT ????? City: FORMTEXT ????? State: FORMTEXT ?? Zip: FORMTEXT ?????- FORMTEXT ????Type of Change (Check all that apply): FORMCHECKBOX Name FORMCHECKBOX Address–NEW (different & replacing) FORMCHECKBOX Address–ADD TO EXISTING FORMCHECKBOX Phone NEW FULL NAME: (First) FORMTEXT ????? (Middle Initial) FORMTEXT ????? (Last) FORMTEXT ????? (only if changing) ORNEW (Company*/Individual*) NAME (only if changing): FORMTEXT ????? *Form W-9 (Required for all Non-BCPS employee modification requests, i.e., non-public schools and businesses) NEW/ADDITIONAL Address: FORMTEXT ????? City: FORMTEXT ????? State: FORMTEXT ?? Zip: FORMTEXT ?????- FORMTEXT ???? CELL or HOME PHONE (REQUIRED): FORMTEXT ?????(please refrain from using BCPS phone #s; provide business phone & Form W-9 if request generated from Accounting) Vendor’s e-mail (REQUIRED): FORMTEXT ?????(use BCPS e-mail for internal employees) Full Name of Requesting School/Office: FORMTEXT ????? Date: DATE \@ "M/d/yy" 2/21/20(location where you receive BCPS inter-office mail that will be written for mail delivery OR Name of non-public school) Requested By-Name (can be self): FORMTEXT ????? Requestor’s e-mail (REQUIRED): FORMTEXT ????? OR CHECK BOX if same as above (if self): FORMCHECKBOX Requestor’s Day Phone (REQUIRED): FORMTEXT ????? Ext: FORMTEXT ????? Fax: FORMTEXT ????? (if Requestor is other than “Self”) Return completed form to: FORMCHECKBOX Individual/Vendor FORMCHECKBOX Requesting Office/School FORMCHECKBOX Both FORMCHECKBOX Return form thru BCPS inter-office mail FORMCHECKBOX e-mail FORMCHECKBOX Both FORMCHECKBOX Fax (for non-public schools) Omission of any information above will delay the processing of your request.F A X T H I S F O R M T O O F F I C E O F P U R C H A S I N G: 410–887–7831Please allow at least ten duty days for processing vendor related requestsDO NOT GROUP MULTIPLE REQUESTS ON A SINGLE FAX – FAX EACH SEPARATELYFor Office of Purchasing Use OnlyModification Completed by: _________________________________Date: ................
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