Vendor Form
BUSINESS INFORMATION
Name/Business Name (as shown on your tax return)
Contact Name
Address (number, street, and apt. or suite no.)
Phone Number
City, State and Zip Code
Email Address
SUBSTITUTE W-9 INFORMATION FOR ABOVE NAME/ENTITY
Check appropriate box for federal tax classification:
Individual/Sole Proprietor
C Corporation
Partnership
Trust/Estate
Limited Liability Company, enter the tax classification (C=Corporation, S= S Corporation, P=Partnership)
Exempt Payee
Enter your Taxpayer Identification Number (TIN) in the appropriate box. The TIN provided must
match the name given on the “Name” line to avoid backup withholding. For individuals, this is your
social security number (SSN). For other entities, it is your employer identification number (EIN).
Beloit College must file a 1099 informational return to the IRS and you are required to provide a
correct TIN or payments may be subject to 31% withholding. Please see the IRS Form W-9
instructions for any assistance.
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Social Security Number
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Employer Identification Number
PAYMENT TYPE
Receive paper checks (Please complete the Authorization Section for the Substitute W-9 portion)
Receive electronic payments (Please complete the Bank Information and Authorization Section)
Accounts Receivable Contact
Email Address for Remittance Advice
Accounts Receivable Phone Number
BANK INFORMATION
Financial Institution Name
Routing Number
Financial Institution City, State and Zip
Account Number
Checking Savings
Financial Institution Phone Number
AUTHORIZATION/CERTIFICATION SIGNATURE
By signing below I certify that the tax classification and TIN information is correct. I also verify my payment type as noted above.
By choosing electronic check option, I further acknowledge the following:
I hereby authorize Beloit College to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries made in
error to the account identified above.
Authorized Signature
Printed Name
Title
Date
click to sign
signature
click to edit