Fillable Vendor-registration Form (Oral Roberts University)

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Vendor-registration Form (Oral Roberts University)

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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:
918-495-6985
E-mail form: vendors@oru.edu
Phone:
918-495-7531/7549
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
__ __ - __ __ __ __ __ __ __
Part I
Part II
ORU Payment Enrollment Form
See page 2 for Terms and Conditions
vendors@oru.edu
Oral Roberts University
7777 S Lewis Ave, Tulsa, OK 74171
918-495-7531/7549
fax: 918-495-6985
Block 1 - INDIVIDUAL OR COMPANY INFORMATION
Individual Company
SSN# __ __ __ - __ __ - __ __ __ __ FEIN# __ __ - __ __ __ __ __ __ __
Name: _________________________________ Name: __________________________________
Address: ________________________________ Address: _________________________________
Physical Street Address (required) Physical Street Address (required)
Address: ________________________________ Address: _________________________________
Mailing Address Mailing Address
_______________________________________ ________________________________________
City, State and Zip Code
City, State and Zip Code
Phone ( __ __ __ ) __ __ __ - __ __ __ __ Phone ( __ __ __ ) __ __ __ - __ __ __ __
Block 2 - FINANCIAL BANK INSTITUTION INFORMATION
Bank Institution Name: _____________________________________________
Institution Account Number: ________________________________________
Nine-Digit Routing Number: __ __ __ __ __ __ __ __ __
Please Check Type of Account: ___ Checking ___ Savings
Block 3 - NOTIFICATION METHOD
Notification of your deposit confirmation will be sent via e-mail.
Email Address (required): _________________________________________________
Signature: ___________________________________________ Date: __________________
Printed Name: _______________________________________ Title : __________________
If you have any questions concerning ACH Transactions, please contact Mary Ellen Crosby or Reba Johnson
918-495-7531/7549 or Fax 918-495-6985.
OFFICE USE ONLY
___ Updated in Banner Processed By: ________________________________ Date: _____________
Page 1
By signing below, I acknowledge that I have read, understand and agree to the Terms and Conditions on Page 2 and that I have
the authority to execute this authorization on behalf of the vendor. This authorization is to remain in full force until Oral Roberts
University has received written notification from me of termination in such time as to afford a reasonable opportunity to act on it.
The standard for any payments made on behalf of Oral Roberts University (ORU) is through
the Federal Automated Clearing House, commonly known as ACH or direct deposit. ACH is
known to be the safest, fastest and most convenient method of payment. To enroll in the
ACH payment process, you must have a valid checking or savings account at a financial
institution that participates in ACH. Most banks and credit unions do participate in ACH.
In order to successfully carry out ORU's fiscal responsibility, the individual or company agrees:
-To the provisions of this ACH agreement;
-To provide accurate enrollment information:
-That any revised authorization will replace any previous authorization;
-That ORU may reverse any duplicate or erroneous credit entries; and
-That the authorization shall remain valid until it is terminated; revoked in writing or
by the closing of the recipient's account at the receiving financial institution.
Submission of the ACH Payment Enrollment Form authorizes ORU to electronically deposit
payments through ACH to the financial institution listed on Page 1 (Block 2) pertaining to
payments issued by the ORU Accounts Payable department for travel, refunds, and/or vendor
payments, whichever is applicable.
Your authorization shall remain in effect until advance written notice of termination is
produced to ORU. Such notice should afford ORU and the financial institution named on
Page 1 (Block 2) reasonable opportunity to take corrective action. It is your responsibility to
provide an updated ACH Payment Enrollment Form to ORU updating any changes to your
financial institution, routing and account number(s).
Notice to ORU should be addressed to: Oral Roberts University
Accounts Payable
7777 S. Lewis Avenue
Tulsa, OK 74171
or
Email forms to: vendors@oru.edu
Fax forms to: 918-495-6985
Page 2
TERMS AND CONDITIONS
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Vendor-registration Form (Oral Roberts University)

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Completed 23 July 2020

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