Vendor Profile (Attach W-9 for all New Vendors)
Vendor Name: __________________________________________________________________________
(If individual, enter last name first)
Taxpayer Identification Number
Mailing Address Payment/Remit Address
Address line 1: ________________________________ Address line 1: ________________________________________
Address line 2: ________________________________ Address line 2: ________________________________________
City/State/Zip: ________________________________ City/State/Zip: _________________________________________
Phone: ____________________________ Ext. ______ Phone: ______________________________________Ext: ______
Fax: ________________________________________ Fax: __________________________________________________
Contact Name: ________________________________ Contact Name: _________________________________________
Email: _______________________________________ Email: ________________________________________________
Type of Organization:
□ Individual Recipient (not owning a business) □ Sole Proprietorship □ Partnership
□ Corporation □ Nonprofit Organization □ Government Entity □ Other: __________________________________________
□ Exempt from backup withholding (Refer to Form W-9 for instructions or questions)
Information below is not required for those classified above as “Individual Recipient” (not owning a business)
Business Classification:
□ Large Business
□ Small Business ( a small business is defined as one with fewer than 100 employees or less than $1million in gross receipts per year)
□ Minority – owned (please select appropriate sub-category below)
□ African American □ Asian American □ Native American □ Pacific Islander □ Hispanic
□ Woman- owned
□ Other
Gender:
□ Male □ Female
Relationship:
Are you an employee, student employee, or retired employee of UWG? □ Yes □ No
Explain any relationship you or any material investor in your company has to any UWG employee:
___________________________________________________________________________________________________________.
Standard Payment Terms: ____________________________________________________________________________________
I certify that the information I have provided on this form is correct.
Signed: ____________________________________________________________ Date: ___________________________________
Please return the completed form by fax or mail to:
Fax to: 678-839-6391
Email to: vendor@westga.edu
Mail to: University of West Georgia
Office of the Controller
