Supplier Information Form

Supplier Information Form - Upload Site

Purchasing Office

ASU West Campus

Building K, Room 104

2400 Gillionville Road

Albany, GA 31707

(229) 500-3103

Contact Information:

Last Name:*

(as shown on your income tax return)

First Name:*

(as shown on your income tax return)

Business Name / disregarded entity name, if different from above:*

Email Address:*

Phone Number:*

Phone

Supplier Information Form / W-9 Upload

Please upload your Supplier Information Forms AND W-9 Form here:*

(You should upload 4 pages)

Drag and drop files here or

Personal Identifiable Information (PII) Notice:

All personal data and special categories of sensitive personal data collected or processed by Albany State University (ASU) must comply with the ASU Cybersecurity Program Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity:

https://www.usg.edu/policies

Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to:

LegalAffairs@asurams.edu

Otherwise, questions concerning GDPR can be forwarded to LegalAffairs@asurams.edu. Typing your name in the box below and submission of this application provides consent to and acknowledgment of the ASU Data Security and Privacy Policy.

Please check the box below to indicate that you have read and understood the PII policy above.

Personal Identifiable Information (PII) Consent:*

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