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Vendor Information Form

MBE-54 OTHER Vendor Information Form REV 26NOV2024
Single Submission
Bulk Excel Submission
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Type of Vend…
Workflow Automation ✦
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Company Information
03. Company Name *
Nova Components LLC
04. DBA (If Applicable)
NovaCo
05. Tax ID # *
78-3220145
06. State of Registration / Incorporation *
Washington
07. Company Website *
novacomponents.com
08. Type of Organization *
Sole Proprietorship
Partnership
DBA
LLC
LLP
C Corp
09. Type of Vendor *
Service Provider
Shipping Company
Software Provider
Maintenance Provider
10. Description of products or services provided *
Industrial conveyor components & spares
11. Company Physical Address (No PO Boxes) *
1200 Industrial Way, Bellingham, WA 98226
13. Affiliate Status *
Not a subsidiary / division of another firm
A subsidiary / division of another firm
14. Primary Contact Name *
Mary Smith
15. Primary Contact Title *
Account Manager
17. Primary Contact Email Address *
mary@novacomponents.com
Payment Terms & ACH Authorization
18. Payment Method & Terms *
MBE's preferred payment method is via ACH. Checks are only issued once per month. If your company requires checks, our terms are NET 60.
ACH-NET 45
Check-NET 60
ACH-NET 30
ACH-NET 45 (Info sent separately)
20. AR Contact Phone Number *
(360) 555-0142
21. AR Contact Email *
ar@novacomponents.com
Acknowledgement & Authorized Signature
28. Acknowledgement
I certify that I am duly authorized to sign this document on behalf of the company / supplier and that, to the best of my knowledge, the information provided is current, accurate, and complete.
29. Authorized Agent Name *
Mary Smith
30. Authorized Agent Title *
Compliance Manager
31. Authorized Agent Phone Number *
(360) 555-0142
32. Authorized Agent Email *
mary@novacomponents.com
AI Vendor Onboarding Review Live
Fields checked
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Missing docs
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Confidence
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Time saved
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What Knowella found in this vendor record Vendor Information · Nova Components LLC
EIN & Tax ID validated (78-3220145)
Matches the business registry.
ACH authorization captured — ACH-NET 30
Payment terms & AR contact on file.
!
Signed W-9 not yet on file
Reminder drafted to the vendor's authorized agent.
Company info & vendor type complete
LLC · Service Provider · Washington.
Authorized signatory captured
Mary Smith · Compliance Manager.
Knowella AI
W-9 reminder sent to Nova Components
Vendor verified · activates once W-9 is returned
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