Fillable UCM Vendor Information Form 2018

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UCM Vendor Information Form 2018

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The UCM Vendor Information Form 2018 form is 2 pages long and contains:

  • 1 signature
  • 6 check-boxes
  • 53 other fields

Country of origin: US
File type: PDF

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Vendor Information Form
(Revised 5‐2018)
New Vendor Update Vendor
Info
UNIVERSITY USE ONLY
Banner Vendor #:
This form must be submitted with a completed IRS W‐9 or W‐8BEN (for foreign entities) form from the vendor. If a
completed W‐9/W8
is not received, your company will not be added to the University database. Your failure to provide
a correct name and Employer Identification Number may subject your payments to a 28% federal income tax withholding.
Links to IRS W-9 and W-8 documents: http://irs.gov/pub/irs-pdf/fw9.pdf https://www.irs.gov/pub/irs-pdf/fw8ben.pdf
Mail or fax completed
forms to:
University of Central Missouri
Procurement
415 E Clark Street, Suite 116
Warrensburg, MO 64093
Phone Number: (660)543-8345 Fax
Number: (660)543-4001
Email: ljbutler@ucmo.edu
Payment Terms are Net 30, unless otherwise stated and agreed to by the University.
Signature:
Date:
Printed Name:
Title:
* I Certify that I have carefully examined this form and I have determined that to the best of my knowledge and belief, the
Information provided is complete and accurate
Legal name of company or business:
(Name
that is used on your Federal Tax Return. If you are a Sole Proprietor of a business the name of the owner of the
business is required.)
Company “commonly known as” Name, if different from above, i.e. DBA:
Purchase Orders Mailing Address:
Line 1:
Line
2:
Line
3:
City:
State:
Zip
E-M
ail
Address:
Phone:
Fax:
Contact Name:
Please indicate preferred method of purchase order receipt
_____FAX _____EMAIL
Payment/Remit Address:
Line 1:
Line
2:
Line
3:
City:
State:
Zip
E‐Mail
Address:
Phone:
Fax:
Contact Name:
Vendor Ownership Type: Please check all that apply
Minority, Female, Person with Disability Owned Business (This business must be at least 51% owned and controlled by one or more
individuals who are minority, female, or a person with disabilities).
___Minority Owned _____Small Business _____State Contract _____Veteran Owned _____Women Owned
No
No
Are you or any Officer, Owner or Partner in this company an employee of University of
Central Missouri?
Are any family members employees of University of Central
Missouri?
If yes, please state who:
University of Central Missouri
ACH Payment Agreement Form
Initial Enrollment Modify/Update
Vendor Name:
UCM Vendor Number:
I (we) hereby authorize University of Central Missouri (hereafter UCM) to initiate ACH automatic deposits (credits) to my account at
the financial institution named below. Additionally, I authorize UCM to make necessary debit adjustments in the event a credit entry is
made in error.
Further, I agree not to hold UCM responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me
or my institution or due to an error on the part of my financial institution in depositing funds into my (our) account. I will notify UCM
immediately of any changes made to my checking account.
This agreement will remain in effect until UCM receives written notification of cancellation from me or my financial institution. Upon
receipt of notice, I understand UCM will need 72 hours to comply with the request and interim deposits may occur.
Primary Phone Number:
Primary Fax Number:
Primary Email Address:
Name of Financial Institution:
Branch / State:
Routing Number: Checking
Account Number:
Name: Title:
Authorized Signature: Date:
Please attach a VOIDED check or deposit slip to verify bank details and routing number.
This form must be returned to: University of Central Missouri
Accounts Payable
Administration Bldg 316
Warrensburg, MO 64093
Or e‐mail to accountspayable@ucmo.edu
Declaration:
Vendor Information:
Vendor Banking Information:
Vendor Authorization:
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UCM Vendor Information Form 2018

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Completed 31 December 2020

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