Legal Name:
Phone:
Address:
E-mail:
City:
State:
Zip:
U.S. Citizen: Yes or No (If no, contact Accounting Payable before giving prize or award)
Are you or have you been a ISU employee during the past 12 months? Yes or No
Event:
Event Date:
Award Amount: $
Check one:
Prize
Award
Description:
Prepared By:
Department:
Phone #
Federal law requires that we have on file a W-9 form with the Social Security number and signature for each
individual or business to which the University makes a non-payroll payment. The IRS may impose a penalty of up
to $500.00 for non-compliance or supplying false information.
.
SIGNATURE: Date:
Individual Receiving Prize or Award
Forward completed form, W-9 and any supporting documentation
to Accounts Payable MS 8219 to complete accurate reporting.
IDAHO STATE UNIVERSITY
921 S. 8
th
Ave. Stop 8219
Pocatello, ID 83209-8219
Phone: (208) 282-6266 Fax: (208) 282-4725
Bengal ID#
Date:
This form must be completed each time an individual receives a
prize or award.
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'RFX
click to sign
signature
click to edit