New Vendor Information Form

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Company Name: _____________________________________________________________________________

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Vendor TIN or SSN (Tax ID Number): _____________________________________________________________

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Name as shown on tax return: __________________________________________________________________

Legal Classification:

✔ C Corporation Individual/Sole Proprietor

S Corporation Limited Liability Company
Partnership Other

２４０００ ３５ｔｈ ａｖｅ ＳＥ， Ｓｕｉｔｅ １０２Ｂｏｔｈｅｌｌ ＷＡ ９８０２１

Remit to Address: ___________________________________________________________________________
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City: _________________________________________ State: Ｗａｓｈｉｎｇｔｏｎ
_____________ Zip: ９８０２１
_____________________

Accounts Receivable Contact: Ｓｔｒｉｖｅ Ｔｅｃｈ Ｉｎｃ

__________________________________________________________________
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Phone: _________________ Fax: _________________ Email: _______________________________________

Preferred method of receiving Purchase Orders: Fax ✔ Email

Ｐｒｏｖｉｄｅｓ ａｃｃｕｒａｔｅ ａｎｄ ａｃｔｉｏｎａｂｌｅ ｄａｔａ ｐｌａｔｆｏｒｍ ｐｒｏｖｅｎ ｔｏ ｏｐｔｉｍｉｚｅ ｍｕｓｃｌｅ ｐｅｒｆｏｒｍａｎｃｅ．
Brief description of services provided: ___________________________________________________________

*An invoice will be required for each requested payment. Payments will be made by check and will be mailed to
the remitting address above, unless otherwise arranged. All payments will be made within University net 30
payment terms.

Business (Diversity) Classification (choose all that apply):

Large Business Non Profit Business
Small Disadvantaged Business Small Service Disabled Vet Owned Business
✔ Small Business Small Woman-Owned Business
Hubzone Business

REQUIRED DOCUMENTATION:
• W-9 or W-8– Please attach a signed copy of the IRS Form W-9 or W-8 BEN: Request for Taxpayer
Identification Number and Certification. Documentation is required at time of contract signature.
o If you are an individual/sole proprietor, a SSN will be required. Additional information may be
required to determine whether a service provider should be classified for federal, state, and FICA
tax purposes as an Employee of the University of Utah or as an Independent Contractor.