Vendor Substitute Form W-9

If you have questions on filling out this form, please email vendor@pima.edu or call 520-206-2079.


If you are a foreign vendor, please complete the appropriate Form W-8 located on www.irs.gov and email to vendor@pima.edu.

 

Person completing the form

 
 

Please answer "yes" if you were asked to complete this form by a Pima College employee.

 

Tax Identification and Classification

 
 
 
 
 
 

EIN=Employer Identification Number, OR SSN=Social Security Number

 
 

Do not include city, state or zip in this field

 
 
 
 
 

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); 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 (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.


Please print your name below to certify that all of the above is true.

 

Vendor Terms and Industry Classification

 

For more information on what a NAICS Code is visit the NAICS Association website at www.naics.com

 
 

Vendor Diversity

 

Select all that apply

 

Vendor Contact Information

 

Please list first and last name

 
 
Phone
 

Only complete the remit address if different than the main address.

 
 
 
 
 
 

Payment/Direct Debit (ACH) Authorization

 
 

I hereby certify that the above information is current and correct. Furthermore, if I have opted for direct deposit payments, I hereby authorize Pima Community College to initiate electronic transfers of funds to the account designated.


Please print your name below if you agree.

 
 
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