Vendor Registration Form & Substitute W-9
Completion of this form ensures that your company will be registered with the College.
It does not guarantee that your company will be contacted for purchases needing a quote or bid.
Name (as shown on your income tax return):
Business Nam
e, if different from above:
Addres
s:
Check appr
opriate box:
Individual/Sole Proprietor Corporation Partnership Limited Liability Company.
Enter the tax classification (d = disregarded entity, c = corporation, p = partnership)
Exempt from backup withholding:
Federal T
ax ID No.
OR Social Security No.
Under penalties of perjury, I certify that: The number shown on this form is my correct tax payer identification number. I have not been
notified by the Internal Revenue Service that I am subject to backup withholding as a result of failure to report all interest or dividends, or
the IRS has notified me that I am no longer subject to backup withholding. I am a U.S. person (including a U.S. resident alien).
Sign Here Signature of U.S. Person Date
P
arent Company (if applicable):
Mailin
g Address (Correspondence & Purchase Orders):
R
emittance Address (Payment of Invoices):
P
ayment Information:
ACH (Automated Clearing House) electronic funds transfer is the preferred method of payment to expedite the
distribution of funds to the vendor.
ABA Routing #: Account #:
Checking Account Savings Account
Email Notification:
Please mail check.
For individuals that live in the State of Illinois, please check this box if you are a SURS Annuitant:
Products/Services that your Company sells
Telep
hone: Fax: Email:
Princi
pal Contacts:
Name
Title/Po
sition Phone Email
1.
2.
3.
Please return this form to Rock Valley College, Business Services Department, Attn: Karen Kerr
(fax) 815-921-4
479 or (email) k.kerr@rockvalleycollege.edu
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome