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Vendor Profile Form For U.S. Entities / U.S. Citizens ONLY
 

Summary: Vendor Profile Form
For U.S. Entities / U.S. Citizens ONLY
Part A-1 Tax Identification Substitute W-9 Form
Please provide your Legal Business Name as used on your Tax Return
Legal Business Name*:
Completed form can be scanned and emailed to vendor@uga.edu or faxed to 706-542-6767
For assistance with completion of this form, please contact vendor@uga.edu or call 706-542-2786 for Part A questions or 706-542-2361 for Part B questions
SECTION A: COMPLETE PARTS I-2 FOR ALL INDIVIDUALS & VENDORS
FEI /EIN# -
D/B/A Name: SSN # - -
Check One: *Individuals enter: Full name as entered on tax return and Social Security Number
*Sole Proprietors enter: Business Owners name on tax return, Business or Trade Name (DBA) a sole proprietorship may have a "DBA
name", but the legal name is the owners name and Owner's Social Security # or FEI/EIN #
*Partnerships enter: Name or Partnership, Partnership's Name as listed on tax return and FEI /EIN#
* Corporation or Exempt enter: Full name as listed on tax return and FEI /EIN#
Remit to Address City ST Zip
Purchase Order
Address
Purchase Order
e-Mail Purchase Order Fax #

  

Source: Arnold, Jonathan - Nanoscale Science and Engineering Center & Department of Genetics, University of Georgia

 

Collections: Biotechnology