Fillable Vendor Registration Form

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Vendor Registration Form

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  • 12 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

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VENDOR/SUPPLIER University Department Requesting Form ____________________
REGISTRATION FORM E-Mail/Fax completed form to:
Oral Roberts University Fax:
918-495-7907
E-mail form: vendors@oru.edu
Phone:
918-495-6688
Company/Individual Name on IRS Record Phone Fax
Company DBA name - Payments will be made to this name Phone Fax
Contact Name Phone Fax
[PR/PO] Primary Business Address/Purchase Order Information
Phone Fax
(Physical Street, City, State, 9-Digit Zip) E-Mail Address and/or Company Website
Contact Name Title
[RE] Remit To Information (If different from above) Mailing address for checks and 1099 reporting Phone Fax
(PO Box or Street, City, State, OK 9-Digit Zip) E-mail Address
Contact Name Title
Parent Company Name and address
Relationship Disclosure (Check all that apply):
[R1] Are you, or any Officer, Director, Owner or Partner in this company, an employee of Oral Roberts University? Yes No
[R2] Is a direct family member of any of the above an employee of Oral Roberts University?
Yes No
[R3] Are you an Alumni of Oral Roberts University?
Yes No
Substitute IRS Form W-9 Certification
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match or
the name given above to avoid backup withholding. For individuals,
this is your Social Security Number (SSN). For other entities, it is your
Employer Identification Number (EIN).
IRS Business Classification (must check one )
[IS] Individual/Sole Propprietor [PR] Partnership
[LL] Limited Liability Entity (D-Disregard entity C-Corporation, P-Partnership
[NP] Non-Profit
[CP] Corporation
[OT] Other _________________________
Designated State Domicile Registration: _______________________________________________________________
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, 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 Internal Revenue Service (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. citizen or other U.S. person (and authorized to sign an IRS Form W-9).
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 additional information refer to: www.irs.gov and form W-9.
Submission of this form is not a contract between Oral Roberts University and any party.
Sign Here Signature of U.S. Person: Date:
Printed Name:
Title:
Social Security Number
__ __ __ -__ __ - __ __ __ __
Employer Identification Number
__ __ - __ __ __ __ __ __ __
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Vendor Registration Form

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Completed 23 February 2020

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