W
SUBSTITUTE W-9 / NEW VENDOR FORM
This form should be used by U.S. Persons: (1) U.S. citizens (2) U.S. resident aliens & (3) entities created
or organized in the U.S. or under the laws of the U.S. PLEASE PRINT LEGIBLY.
REQUIRED: Revised: 07/07/14
Name as shown on the income tax return (Sole proprietors & disregarded LLC’s must enter the owner’s name.):
Business Name/Disregarded Entity Name, if different from above:
Permanent Address (for tax and general correspondence):
Exempt Payee Code (if any) Exemption from FATCA reporting code (if any)
ID number for the name on the tax return and first line of this form (SSN for individual and disregarded LLC owned by an individual):
Social Security Number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___ or EIN (if no SSN): ___ ___ - ___ ___ ___ ___ ___ ___ ___
Tax Designation (must check one): Corporation Partnership Trust Estate
Individual or Sole Proprietor Government Exempt under IRC Sec. 501(c)____
Limited Liability Company that files tax returns as a: Partnership (Form 1065) or Corporation (Form 1120/1120-S)
(LLC disregarded for tax purposes should report the owner’s information in this section and on the first line of this form.)
Tax Residency Status (must check one):
U.S. Citizen U.S. Permanent Resident U.S. Resident Alien* Nonresident Alien*
Entity created or organized in the U.S. or under the laws of the U.S. Not Sure* VISA Type*___________
OPTIONAL:
Remittance Address if different from above address (campus address for students):
REQUIRED:
Certification / Signature
Under penalties of perjury, my signature certifies that:
(1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued), and
(2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS that I am
subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to
backup withholding, and
(3) I am a U.S. person (including a U.S. resident alien)
(4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions – You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have
failed to report all interest and dividends on your tax return. For real estate transactions, number 2 above does not apply.
The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.
Signature: Date:
Printed Name: Title:
*
Nonresident aliens and individuals unsure of their status should fill out the International Visitor/Vendor Information Form. Resident aliens who are not
permanent residents should fill out both forms. Entities not created or organized in the United States or under the laws of the United States should fill out
and submit the appropriate IRS Form W-8.
The College of Wooster · Office of Purchasing and Contracts
1101 North Bever Street · Wooster, OH 44691 · Fax: 330-263-2521 · Phone: 330-263-2367
