USA Decom New Vendor Information Request Form

Vendor Business Name*

Vendor Contact/Representative Name*

First Last

Vendor Email*

Vendor Phone*

Product(s) or Service(s) Offered*

Vendor Service Zone (Region, State, County, City or Nationwide)*

Vendor Type (check all that apply)*

What services are you providing for USA Decom?*

Selling Products to USA Decom (no onsite work or presence)
Performing Services at Project Site
Recycling Services

Vendor HQ Address*

Street Address Suite/PO Box/Building City State ZIP Code

Vendor Payment Remit To Address*

Same as previous

Street Address Suite/PO Box/Building City State ZIP Code

Accounts Receivables Contact*

First Last

Accounts Receivable Email Address*

Accounts Receivable Phone*

Bank and Payment Information

Accepted Payment Methods*

Credit Card
ACH/eCheck
Check
Wire

Name on Bank Account for Wire or ACH

Name of Bank

Type of Bank Account

Routing Number for Wire

Routing Number for ACH (if different than Wire)

Account Number

Bank Address

Street Address Suite/PO Box/Building City State ZIP Code

Required Documents for Companies That Sell Products

Please upload your company’s completed W9 Form.

Upload W9*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Required Documents for Companies Working at Project Site

Please upload:

1. Your W9

2. Certificate of Liability Insurance Naming USA Decommissioning LLC as an additional insured

3. Proof of Workman’s Comp Insurance

4. Proof of Auto Insurance

Upload Documents*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 3.

Terms*

By submitting our company’s insurance documentation to USA Decom, I confirm that all of our W-2 employees are covered under workers’ comp and any subs/independent contractors we hire to perform work for USA Decom are covered under the same or higher levels of liability, auto, and workers’ compensation insurance.

Required Documents for Companies That Provide Recycling Services

Please upload:

1. Your W9

2. Proof of Environmental Insurance.

Upload Documents*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 3.

Will your company be at the project site?*

No
Yes

Please also upload the following documents:

1. Certificate of Liability Insurance Naming USA Decommissioning LLC as an additional insured

2. Proof of Workman’s Comp Insurance

3. Proof of Auto Insurance

Upload Documents*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 3.

Terms*

By submitting our company’s insurance documentation to USA Decom, I confirm that all of our W-2 employees are covered under workers’ comp and any subs/independent contractors we hire to perform work for USA Decom are covered under the same or higher levels of liability, auto, and workers’ compensation insurance.

Email

This field is for validation purposes and should be left unchanged.