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 Name if different from above
Check appropriate box for federal tax classification:
Individual/sole proprietor Corporation
S Corporation Partnership
Trust/estate Limited liability company
Address (number, street, and apt or suite no.):
City
Taxpayer Identification Number (TIN)
Social Security Number
OR Employer identification number
Under pena
lties of
perjury, I certify that: The number shown on
t
his
form
i
s
m
y
co
rrect
tax payer identification number. I have not been notified by the Internal Revenue
Service that I am subject to back 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
Mailing Address (Correspondence & Purchase Orders):
Telephone
Fax
E-Mail
Are you certified as a MBE or disadvantaged vendor by an organization other than the State of Ohio? If yes, please indicate type
and submit a copy of your certification
OMSDC NMSDC Franklin County City of Columbus
OTHER
Products/Services that your company sells
Check Remit Address (Payment of Invoices):
Title/Position
Please return this form or any future changes to the above information to Columbus State Community college, Procurement,
purchasing@cscc.edu or fax 614-287-2545
State
Zip
Principle Contact Name
Are you a Minority Business Enterprise certified with the State of Ohio? If yes, please indicate which one:
EDGE
MBE
Other
