BYRON-BERGEN CENTRAL SCHOOL DISTRICT

District Office 6917 West Bergen Road Bergen, NY 14416-9747 (585) 494-1220

Please return W-9 form and Vendor Information Worksheet to Vicky Shallenberger at vshallenberger@bbschools.org or Lori Prinz at lprinz@bbschools.org. Forms can be faxed to (585) 494-2613 as well.

VENDOR INFORMATION SHEET Purchasing Information:

Company Name d/b/a Address

City, State, Zip

Phone Number

Fax Number

Payment Information: Company Name d/b/a
Address

City, State, Zip

Phone Number

Fax Number

Type of Entity:	Corporation	LLC	Partnership	Individual Select one

Website Address

Challenge, Engage, and Nurture

BYRON-BERGEN CENTRAL SCHOOL DISTRICT

District Office 6917 West Bergen Road Bergen, NY 14416-9747 (585) 494-1220

Challenge, Engage, and Nurture