Vendor Portal

Vendor Registration

Register to become an approved vendor for Medical Shielding Solutions. Complete the required forms and agree to our confidentiality terms.

Start Registration Questions?

Confidential Information Notice

The information you provide in this registration is considered confidential and will be used solely for vendor qualification and payment processing purposes. Medical Shielding Solutions maintains strict data protection protocols and will not share your information with third parties outside of necessary business operations.

Confidentiality Agreement

By submitting this vendor registration, I/We agree to the following terms:

Confidentiality: All information provided is confidential and will be treated as such.

Purpose Only: Information will only be used for vendor qualification and payment processing.

No Distribution: Vendor information will not be distributed to unauthorized parties.

Data Protection: We comply with applicable data protection regulations.

Secure Storage: All documents will be stored securely with restricted access.

I/We have read and agree to the confidentiality terms above *

Vendor Registration Form

Complete all sections below. Once approved, you will receive access to the vendor portal for document submission.

Primary Contact

Contact Name *

Title/Position

Email Address *

Direct Phone *

W-9 Information

After approval, you will receive instructions to upload your completed W-9 form securely.

Federal EIN *

Legal Business Name *

Tax Classification *

Vendor Type/Service Category *

Insurance Information

After approval, you will receive instructions to upload your insurance certificates securely.

Insurance Provider

Policy Number

General Liability Coverage

Workers Comp Coverage

Expiration Date

ACH Payment Information

Secure Payment: Your banking information will be encrypted and stored securely. After approval, you may submit banking details through our secure vendor portal.

Bank Name

Account Type

Routing Number

Account Number (Last 4)

Full account number will be requested through secure portal after approval.

Terms & Conditions

By submitting this form, I certify that:

All information provided is accurate and complete
I am authorized to submit this registration on behalf of the company
The company maintains current insurance coverage as indicated
I agree to notify Medical Shielding Solutions of any changes to this information
I understand that approval is subject to review and verification

I/We have read and agree to the terms and conditions above *

Once approved, you will receive an email with instructions to access the secure vendor portal.

Need Help with Your Registration?

Our vendor relations team is here to assist you with any questions about the registration process.

Email Us

[email protected]

We respond within 24-48 hours

Call Us

720-936-3909

Mon-Fri: 8am - 6pm EST