San Diego Community College District Supplier ID #
SDCCD SUPPLIER INTAKE/SETUP FORM
☐ New Supplier: Complete ALL the information below.
☐ Existing Supplier: Enter Supplier ID # (in box at top right) and indicate changes below.
☐ Employee
☐ Student
*DBA Name (as shown on your invoice):
Primary Contact Name:
New Address (or moved to):
Old Address (if moved from):
☐ Add sequence ☐ Add Change.
City: State: Zip Code:
Telephone: Fax: Email:
Vendor Website Address:
Category Code:
New Vendors must submit a completed &
SIGNED W-9 Form to effect payment.
ClickheretoretrievetheW‐9fromtheIRS
http://www.irs.gov/pub/irs-pdf/fw9.pdf
*Notification of Company/Corporation name change MUST originate from vendor.
SMALL AND DISADVANTAGED BUSINESS
ENTERPRISE CERTIFICATION SECTION
This section MUST BE COMPLETED for the District's State Reporting.
Business Category
Ethnicity
☐ Minority-Owned ☐ Native American/Alaskan Native ☐ Hispanic/Latino
☐ Woman-Owned ☐ Asian/Pacific Islander ☐ Caucasian/White
☐ Disabled-Veteran-Owned ☐ Black/African American
Consistent with State law, administrative regulations, and the District's Equitable Opportunities
for Business Enterprises Program, a specific declaration as to your status is required.
SDCCD Employee: Enter Name & Email Address
Name:
Email Address:
