Name of Consultant:
SS # or Federal ID Number:
Billing Address:
Phone #:
Fax #:
Email:
Type of Organization:
___Individual (not owning a business) If checked, please sign and date below to complete.
If not an Idividual, please complete all questions below and sign and date to complete.
___Sole Proprietor ___Partnership
___Corporation ___Government Entity
___Other (Please describe) ________________________________________________________________________
___Exempt from backup witholding (Refer to W-9 for instructions or questions)
Type of Business
___Large Business ___Small Business
___Minority Owned (please select appropriate sub-category below)
___African America ___Asian American ___Native American ___Pacific Islander ___Hispanic
___Female Owned ___Other
Gender:
___Male ___Female
Consultant Signature: ________________________________________________________________________
Date: ________________________________________________________________________
Dates of Service:
Description of Services:
*Amount of Compensation:
Is consultnant currently employed by another Board of Regent Institution? ___Yes ___No
*If yes, please also complete a separate form for Employment Compensation Agreement Between Institutions.
Approved by: ______________________________________________________________
Date: ______________________________________________________________
3/13/2015
AUTHORIZATION FOR EMPLOYMENT OF CONSULTANTS
**EMPLOYEES OF UWG ARE NOT ELIGIBLE AS CONSULTANTS**
Consultant should complete the below information if there is no vendor profile on file or if there
have been any changes in profile since the last dates of service.
The below section should be completed by UWG employees only:
*Do not include reimbursable expenses as part of the amount of compensation. Non-employee travel
should be completed on a separate form and issued through the UWG Travel Department.
I certify that the information provided on this form is true and correct and that the above
consultant was NOT employed by the University of West Georgia during the above dates of
service:
** Attach this authorization to the Check Request Form **
consultant