Vendor Set Up Form (DPG-000-73) – Drug Plastics & Glass Co., Inc.

Sections 1-6 to be filled out by vendor.

Section 1

Vendor Name*

Vendor #

(Assigned by Accounting Dept.)

Phone #

Fax #

Duns #

Mailing Address*

Mailing Address Street Address*

Mailing Address Address Line 2

City*

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Mailing State

State*

ZIP / Postal Code*

Country*

Remit to Address

Same as mailing address

Remit to Address Street Address

Remit to Address Address Line 2

City

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Remit to Address State

State*

ZIP / Postal Code*

Country*

A/R Contact

A/R Email

A/R Phone

Type of Purchase

Raw Materials
Packaging
Service / Repair
Maint. Repair / Operations
Other

Description of Goods/Services

Vendor Payment Terms

Sales Email

Sales Phone

Section 2

BILLING INFORMATION INSTRUCTIONS

Preferred method of invoicing is by PDF via e-mail to: DPGAccountsPayable@drugplastics.com Invoices should be one per purchase order, not multiple purchase orders on one invoice

Section 3

CREDIT CARD INFORMATION - PREFERRED FORM OF PAYMENT

Our preferred method of payment is Credit Card. We offer payment by credit card through Bank of America. DPG will sign you (the vendor) up. Bank of America will send you a welcome e-mail explaining the process. First payment will provide you with logon and password information to retrieve credit card information. Please contact to DPGAccountsPayable@drugplastics.com or call Bethany Petery @ 610-369-5368, or Kristi Cowger @ at 610-369-5196 if you have any questions.

Credit Card Payment

Yes
No

Section 4

ACH INFORMATION FOR DIRECT DEPOSIT PAYMENT - 2ND PREFERRED FORM OF PAYMENT

Bank Institution

Bank Routing #

Bank Account #

Remittance E-mail Address

Bank Account Type

Checking
Savings

Section 5

Check all that apply

Bussiness Size

Large Business
Small Business

No. of Employees

Minority Owned

Minority-Owned

Choose one of below

Please Specify*

The Vendor may wish to review the definition for the above categories in the Federal Acquisition 19.7 or 52.21908 at www.acquisition.gov/far. Supplier may also refer to the Small Business Administrations website at www.sba.gov/size/, or contact your local SBA office. By offer submission, if the subcontractor is a small business concern in FAR 48 CFR Part 19, subcontractor verifies that its SAM profile is current, accurate, and complete as of the date of offer for the subcontract .

Section 6

Please Enter Your DPG/DPC Contact Below

DPG/DPC Contact*

Date*

DPG/DPC Contact Email*

Section 7

DPG/DPC Approval Routing (3 approval necessary)

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Director/VP of Requesting Dept.

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Date

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Director/VP of Purchasing

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Date

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Controller/CFO

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Date

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Accounts Payable

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Date