Vendor Conflict of Interest Disclosure Form
Vendor Information
Vendor Name
Contact Person
Email
Phone
Disclosure Questions
Do you, or any of your employees, have any family, financial, or other relationships with employees of our company?
Yes
No
If yes, please provide details:
Are there any business interests, affiliations, or arrangements that could be perceived as a possible conflict of interest?
Yes
No
If yes, please provide details:
Certification
I certify that the information given above is complete and accurate to the best of my knowledge.
Authorized Signature
Date