Instructions for Completing this Form
This form substitutes for the IRS W-9 form. Complete this form if you will receive payment from the State of New Mexico
and/or you are a vendor who provides goods and services to the State of New Mexico. To comply with the Internal Revenue
Service (IRS) regulations regarding 1099 reporting, the State of New Mexico is required to collect the following information
to be completed on the Substitute W-9 form. The information collected on this form will allow the State to confirm that our
records contain the official name of your business, the Tax Identification Number (TIN) that the IRS has on file for your
business and business type.
Check the appropriate box(s) that this form is to be utilized and fill in the corresponding section(s) indicated next to the
box(s) checked.
PART I: VENDOR INFORMATION
1. Legal Business Name Enter the legal name as registered with the IRS or Social Security Administration.
2. DBA/Trade Name Individuals leave blank. Sole Proprietorships: Enter DBA (doing business as) name. All Others:
Complete only if business name is different than Legal Name.
3. Entity Type Check ONE box which describes business entity. If a current, past, or becoming a state employee,
please also mark the State of New Mexico Employee box and enter the Business Unit number for the agency. Also,
provide the 6 digit employee ID as assigned in SHARE HCM in the Part II Taxpayer Identification Number (TIN) &
Taxpayer Identification Type section and mark the Employee ID box.
4. 1099 Reporting Check the appropriate box that applies to the type of services being provided to the State. If the
type of service is not specifically stated, enter the type of service in the Other box.
PART II: TAXPAYER IDENTIFICATION NUMBER (TIN) & TAXPAYER IDENTIFICATION TYPE
1. Taxpayer Identification Number Enter TIN with no dashes in the boxes provided
a. TIN is always a 9-digit number. Provide the Social Security Number (SSN) assigned by the Social Security
Administration (SSA) or the Federal Employer Identification Number (FEIN) assigned to the business or
other entity by the Internal Revenue Service (IRS).
b. Employee ID is always a 6-digit number. Provide the employee ID assigned by the State of New Mexico for
payroll processing in SHARE HCM.
2. TIN Identification Type Mark the appropriate box for the TIN provided above.
PART III: ADDRESS
1. Address Where correspondence, payment(s), purchase order(s) or 1099s should be sent.
a. Employees If a current employee, please provide this following:
i. Address Line #1: State Agency Name
ii. Address Line #2: Field Office Mailing Address
iii. Address Line #3: N/A
b. CDBG When providing a Community Development Block Grant (CDBG) remittance address, enter CDBG on
line #1 and entities remittance address in address line #2
2. Remittance Address If different than Address
3. Zip Code and Phone Number The 5 + 4 code will be required to be entered for all zip codes. If the last 4 digits
are unknown, then 4 zeros (0) can be entered. Do not enter the “-“ as part of the zip code. When entering the
phone number, only enter the 10 digit number. Do not enter the “( )” or “-“ as part of the phone number.
PART IV: CERTIFICATION
By signing this document you are certifying
t
hat all information provided is accurate and complete. The person signing this
document should be the partner in the partnership, an officer of the corporation, the individual or sole proprietor noted
under legal name above, or the New Mexico State Employee for which the vendor account is established.
Identifying information is required of the person signing the form.
PART V: OPTIONAL DIRECT DEPOSIT (ACH) You may elect to receive payments from the State of New Mexico through
Automated Clearing House (ACH) direct deposit. Please provide a copy of a voided check or letter from financial institution
with the banking information. Without one of the two items, ACH information WILL NOT be entered and payments will be
made by warrant. Select the type of account being provided.
I Acknowledge Print name and sign to acknowledge the IAT warning and to authorize the State of New Mexico to initiate
direct deposit of funds to your financial institution provided.
Privacy Act Notice Section 6109 requires you to furnish your correct TIN to persons who must file information
