Please complete this Vendor Information Request along with the attached W-9 form.
Email, mail, or fax to the Illinois Valley Community College Purchasing Department, using the information
below.
S
ECTION 3: V
ENDOR CLASSIFICATION
U.S. Resident
Please attach W-9 Form
Non Resident Alien
Please attach W-8BEN Form
Businesses:
Please select the appropriate classification
Foreign Vendor with U.S. Presence
Please attach W-8ECI Form
Foreign Vendor
Please attach W-8BEN-E or W-8EXP Form
SECTION 2: ILLINOIS DEPARTMENT OF CENTRAL
MANAGEMENT SERVICES BUSINESS
E
NT
E
RP
RI
S
E
PRO
G
RAM
CL
AS
S
IFICATION
U.S. Citizen
Please attach W-9 Form
City State Zip
Purchasing Contact Name
PO Telephone:
Business,
PO Fax PO E-Mail Address
Cell, or Home
Remittance Address, if different than above City State Zip
Accounts Receivable Contact Name
AR Telephone AR E-Mail Address
Type of product or services your company provides:
Name of person at IVCC requesting this information:
Phone: 815-224-0417
Fax: 815-224-3294
E-Mail: Purchasing@ivcc.edu
Community College
Purchasing Department
815 N. Orlando Smith Road, Oglesby, IL 61348
Veteran Owned Business Enterprise (VBE)
Sheltered Workshop (SWS)
Minority Business Enterprise (MBE)
Persons with Disabilities Enterprise (PBE)
Female Business Enterprise (FBE)
Individuals: Please select the appropriate classification
U.S. Citizen
Please attach W-9 Form
Legal Business or Individual Name
SECTION 1: VENDOR INFORMATION
Parent Company Name (if different than above)
Physical Address
Mark this checkbox if the social security number listed on the IRS W-9/W-8 form for the above named business is
that of a current Illinois Valley Community College student.
Your Company Identification Number (FEIN):
