Louisiana Tech University
CONTRACT FORM for BUSINESS ENTITIES performing PERSONAL, PROFESSIONAL,
CONSULTING or SOCIAL SERVICES CONTRACTS
Name of Company:
(Complete this form on behalf of the Company you own or represent. Also complete the individual checklist.)
This form is NOT required if the company is a sole proprietorship.
Services to be performed:
1. What type of entity is the company? (corporation, partnership, limited liability
company, etc.) _________________________________
2. Was the company formed in Louisiana? Yes No
2.a. If No, provide a copy of the company’s Certificate of Authority from the Louisiana
Secretary of State.
Out-of-State companies must register with the Louisiana Secretary of State before doing business in
Louisiana unless the company meets an exception. If the company is not registered, contact the Louisiana
Secretary of State before entering this contract.
3. If the company is a corporation, provide a copy of the most recent Disclosure of
Ownership Form that was filed with the Louisiana Secretary of State.
Before a corporation may enter a contract with a Louisiana State agency, including Louisiana Tech, the
corporation must provide a copy of a Disclosure of Ownership form that has been filed with the Louisiana
Secretary of State.
4. Is any person who owns more than 5% of the company
a current student or employee of Louisiana Tech University?
Yes No
If Yes, contact Purchasing Office before executing contract.
5. Was any person who owns more than 5% of the company
an employee of Louisiana Tech University at any time within
the previous two (2) years? Yes No
If Yes, contact Purchasing Office before executing contract.
6. Complete Louisiana Tech’s Signature Authorization Form. If you have not received a
copy of this form, your contract initiator will provide you a copy.
By signing below, I hereby declare and affirm the information provided herein to be true and accurate.
