Vendor Onboarding

Enriched Senior Living — New Vendor Registration

Website (leave blank):

Additional Contacts (optional)

Add contacts for your Sales Representative, Accounts Receivable, or Accounting department.

Address

Street *

City *

State *

ZIP *

Service Locations

Service Locations *

Check all communities you provide services to. All vendors are set up under the Enriched Senior Living parent entity, with selected communities added as service locations.

ACH Payment Setup (optional — but encouraged for faster payment)

Account Type

Bank Name

Account Number

Routing Number

File Uploads

W-9 *

Certificate of Insurance (COI) (optional)

Vendor Contract (optional — your standard contract if you have one)

Authorization

Authorized Signature (type full name) *

By typing your name above, you certify that the information provided is accurate and authorized under ESIGN Act.

Date *

Vendor Onboarding

Company Information

Additional Contacts (optional)

Address

Service Locations

ACH Payment Setup (optional — but encouraged for faster payment)

File Uploads

Authorization

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