MojaveWaterAgency VENDOR INFORMATION FORM COMPANY Company Name: Primary Contact: Primary Address: City:State:ZIP Code: Phone:E-mail:Website: BILLING Billing Contact: Remittance Address: City:State:ZIP Code: Phone:E-mail:Website: PAYMENT Payment Method: Check is the default payment method Or To receive electronic payments, please sign up at: https://enrollment.nvoicepay.com/?customer=MojaveWater ADDITIONAL DOCUMENTS NEEDED W-9 Submitted By:Date: Form v1 6.22.22 MojaveWaterAgency13846 Conference Center DriveT | 760-946-7000 Apple Valley, CA 92307F | 760-240-2642 www.mojavewater.org