New Supplier Fact Sheet - TEP.com

UNISOURCE ENERGY CORPORATION and SUBSIDIARIES
NEW SUPPLIER FACT SHEET FORM
ADDRESS, CONTACT & SUPPLIER PROVISION
INFORMATION
Purchase Order Address (PO’s will be sent to this address)
ORGANIZATION SECTION
Company Name:
Manufacturer’s Authorizing Agent or c/o:
(If Applicable)
Owner’s Name:
(If Company is a DBA)
Street of PO Box:
Legal Structure:
City State: Zip: LLC LP LLP Corporation Partnership
County: Country: Sole-Proprietorship
Must Provide SS# & Name on SS# - see below
Sales Contact:
Phone Number:
Fax Number:
Foreign Company
Must Provide W-8, (BEN,ECI,EXP,IMY) or Form 8233
Email Address:
(REQUIRED as Purchase Orders are sent electronically)
Supplier Provisions:
(Please give a quick description of type of service or goods supplied)
Federal Employer’s
Tax ID Number:
REQUIRED
Social Security Number:
Material Description: (If Applicable)
Services Description:
Social Security Number Name:
Arizona Sites Served:
Arizona Transaction Privilege License (sales tax):
Tucson Nogales Kingman Lake Havasu No Yes Number
Flagstaff Prescott Show Low Cottonwood # REQUIRED if applicable
INVOICE SUBMISSION SECTION
How will invoices be submitted to us? (See Attached Accounts Payable Document for Instructions) Email Fax Mail
(Electronic Presentation of Invoices Preferred)
Are Master Card Payments Accepted? Yes No
Payment Terms are Net 30 unless otherwise negotiated with Procurement & Contracts Department.
PAYMENT SECTION
ACH (Automated Clearing House)/EFT (Electronic Funds Transfer) is the only Payment Method available unless otherwise
agreed to by the Accounts Payable Dept.
Financial Institution Name/Branch:
Account Name: Account Type: Checking Savings
Routing Transit Number (ABA):
Account Number:
ACH Remittance Advice Notification Method: Email:
Fax Number:
REQUIRED if choosing ACH
ACCOUNTS RECEIVABLE ADDRESS & CONTACT SECTION
Remit to Address
Street or PO Box:
City: State: Zip: County: Country:
Accounts Receivable Contact Name:
Phone Number:
Email Address:
Form 7274 Page 2 of 5