Fillable Rev: 180402 (City University of New York)

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Rev: 180402 (City University of New York)

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  • 18 check-boxes
  • 34 other fields

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File type: PDF

U.S.A. forms for City University of New York

BROWSE CITY UNIVERSITY OF NEW YORK FORMS

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Rev: 180402
Page 1
Substitute Form W-9
Request for Taxpayer Identification Number & Certification
Do not complete if you are a CUNY employee (Refer to instructions on page 3)
For CUNY Use Only:
HC
PS
NR
Part I: Which CUNY college requested you to complete this form?* (This section must be completed)
College Name: ______________________________ Name of College Contact Person: ___________________________________
Contact’s Email: ________________________________________________________ Phone Number: ______________________
Part II: Vendor or Payee Information* (This section must be completed)
1. Legal Name:
2. If you use a DBA (Doing-Business-As) name, please list below: (Optional)
3. Entity Type (Check ONE only):
Corporation Government Agency including Hospital Non-Profit including Hospital Foreign Individual/Entity
Individual/Sole Proprietor Partnership LLC Profit Education Other _____________________________________________
4. What are you supplying to CUNY? (Check ALL appropriate box(es))
Merchandise Telegram/Telephone/Freight/Storage Services
Health Care Service Attorney Other Services ________________________________________________________________________
Part III: Taxpayer Identification Number (TIN) Information* (This section must be completed)
1. Enter your TIN here: (If your TIN is a SSN, DO NOT email form but mail or fax to CUNY Vendor Records Management Unit)
2. Taxpayer Identification Type (Check ONE only):
Employer ID No. (EIN) Social Security No. (SSN) Individual Taxpayer ID No. (ITIN) N/A (Foreign Individual/Entity)
3. Exemption Code for Backup Withholding ___________________ 4. Exemption Code for FATCA Reporting ___________________
Part IV: Main Business Address* (This section must be completed)
Number, Street, Apartment or Suite Number
City, State, Zip Code, Country
Visit CUNY Procurement Web Site
Rev: 180402
Page 2
Part V: Ordering Address (Optional) (Complete this section if your Ordering Address is different than the above Main
Business Address)
Number, Street, Apartment or Suite Number
City, State, Zip Code, Country
Email:
Part VI: Vendor Contact Information – Individual Authorized to Represent the Vendor* (This section must be completed).
Please refer to instructions. Form will be rejected if this section is not completed correctly)
Vendor Contact Person:
Email:
Title: __________________________________________________________________ Phone Number: ______________________
Part VII: New York State SFS Vendor Information
If you already have a New York State SFS Vendor Number,
please enter here:
Part VIII: New York City FMS Vendor Information
If you already have a New York City FMS Vendor Number,
please enter here:
Part IX: Signature* (This section must be completed)
*Please note that all required fields in Part I, II, III, IV, VI, and IX must be completed before you sign and submit this form.
Under penalties of perjury, I certify that:
1) All information (including tax ID number) provided on this form is provided by me and is correct to my best knowledge; and
2) I am a US citizen or a US person; and
3) The entity of the tax ID provided above is not subject to backup withholding due to failure to report interest and dividend income; and
4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Sign Here:
______________________________________________________ __________________________________________________
Signature Email
______________________________________________________ _____________________________ __________________
Print Preparer's Name/Title Phone Number Date
Submit form (Page 1 and 2 Only) to: CUNY Vendor Records Management Unit
By mail to: 230 West 41st Street 5th Floor, New York, NY10036-7207
By fax: (646) 664-3910
Or email to: cuny.vendor@cuny.edu
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Rev: 180402
Page 3
Instructions for Completing Substitute Form W-9
Important:
• The City University of New York (CUNY) must obtain your correct Taxpayer Identification Number (TIN/SSN/ITIN) to report
income paid to you or your organization. Information on the Substitute W-9 is required in order to comply with the Internal
Revenue Service requirements. Lack of required documentation may delay the issuance of future purchase orders and/or
payments.
• This is NOT a bidder request form. Completing this form will not add you to any CUNY bidder list. Complete this form only if
you are requested to do so by CUNY.
• Please do not complete this form if you are a CUNY employee or a CUNY Research Foundation employee during the last 2
years (unless you are specifically instructed to do so by the college).
• If the form contains a SSN, please DO NOT email form but mail or fax the form directly to the City University of New York Vendor
Records Management Unit.
• *Please note that all required fields in Part I, II, III, IV, VI, and IX must be completed.
Instructions:
Part I: Which CUNY college requested you to complete this form?*
Please provide college name, name of college contact person, email and phone number. If you are doing business with multiple CUNY
colleges, please provide the information of the college with the most recent purchase order.
Part II: Vendor or Payee Information*
1. Legal Name: For individuals, enter the name of the person who will do business with CUNY (or receive payment from CUNY)
as it appears on the Social Security card or other required Federal tax documents. An organization should enter the name shown
on its charter or other legal documents that created the organization. Do not abbreviate names.
2. DBA (Doing Business As): Enter your DBA name.
3. Entity Type: Mark the Entity Type. Check ONE only.
4. What are you supplying to CUNY? Mark the appropriate check box. Check ALL appropriate box(es).
Part III: Taxpayer Identification Number (TIN) Information*
1. Taxpayer Identification Number: Enter your nine-digit Social Security Number (SSN), Individual Taxpayer Identification
Number (ITIN) or Employer Identification Number (EIN). To ensure your privacy, if the form contains a SSN, please DO NOT email
form but mail or fax the form directly to the City University of New York Vendor Records Management Unit.
2. Taxpayer Identification Type: Mark the type of identification number provided.
3. Exemption Code for Backup Withholding: Enter the Exemption Code if you are exempt from backup withholding.
4. Exemption Code for FATCA Reporting: Enter the Exemption Code if you are exempt from FATCA Reporting.
Part IV: Main Business Address:* List the location where your main business is physically located.
Part V: Ordering Address: Complete this section if your Ordering Address is different than the main business address in Part IV.
Part VI: Vendor Contact Information*
Please provide the contact information for an executive at your organization. This individual should be a person who makes legal and
financial decisions for your organization. All information including name, title, telephone and email must be completed. For New York
State vendors, please be sure to provide email to ensure you will receive invitation to join eSupplier Vendor Self Service. The State’s
eSupplier portal allows vendors to manage their address/contact information and search details about their payments.
Part VII: New York State SFS Vendor Information
New York State SFS Vendor Number: If you already have a New York State SFS Vendor Number, please enter information in the boxes
provided.
Part VIII: New York City FMS Vendor Information
New York City FMS Vendor Number: If you already have a New York City FMS Vendor Number, please enter information in the boxes
provided.
Part IX: Signature*
This form must be signed before submitting to the CUNY Vendor Records Management Unit.
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Rev: 180402 (City University of New York)

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Completed 25 October 2021

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