SequoiaSD Vendor Authorization Request Form SequoiaSD Vendor Authorization Request Form Please complete this form for the Vendor chosen. SequoiaSD will reach out to the Vendor to setup the Vendor Agreement to ensure payment is rendered in a timely manner. Participant Name * First * Last Regional Center * Vendor Name * Contact Name * Contact Name First First Last Last Contact Email Address * Contact Phone Number * Service Planning to Provide * I am planning for this vendor's employees to provide personal care to the participant. * Yes No I acknowledge that I must collect and approve every invoice from the vendor BEFORE SequoiaSD remits payment, and I will send the approved invoice to sequoiavendors@sequoiasd.com. * Yes Your Name * Your Name First First Last Last Your Email Address * Date Authorization * By submitting this Vendor Authorization form, I consent for payment to be rendered to the listed Vendor on behalf of the aforementioned Person Served. I further acknowledge that it is the responsibility of the Vendor to send the invoice to the Person Served / Authorized Designee for approval prior to SequoiaSD remitting payment. Submit
