Vendor-Payee Form

State of Oklahoma Office of Management & Enterprise Services Vendor Maintenance Vendor/Payee Form Change Existing Address # Additional Address The State of Oklahoma requires the following information for all new vendors (payees) before any payments can be made. This information is used to establish you in the State's vendor file. The form must be signed to be valid. This form should not be used to establish Garnishment Vendors or State Employee Vendors. AGENCY SECTION Agency Name Contact Name 1099 Reportable Status Add: Remove: Phone #: Fax#: Attention Paying Agency: Please check the Add box on the left if payments to this vendor/Payee are represented by Account Codes listed on page 3 of this form. If the vendor is incorrectly showing as 1099 Reportable, check the Remove box. The PeopleSoft system requires specific details regarding the type of transaction. Please check the box that applies to this vendor: 1 - Rents 6 - Medical & Health Care 2 - Royalties 7 - Non-Employee Compensation 3 - Prizes & Awards 10 ­ Crop Insurance Proceeds 14 ­ Gross Proceeds to an Attorney PeopleSoft (Oracle) 10-digit Vendor #: VENDOR/PAYEE SECTION (Please print or type this information. Complete and fax to requesting State Agency) Company Name (or Individual, or Government Entity) Name on IRS Record (if different than above) VENDOR/PAYEE TIN/SSN: Business Address: (PO Box or Street, City, State, 9-Digit Zip Required) EFT Payment Notification E-mail Address Phone # Phone # Fax # Fax # This email will be notified when an EFT payment is made. Optional Address ­ check as appropriate: If different, Pricing Ordering Invoicing Remitting Returning Phone # (PO Box or Street, City, State, 9-Digit Zip Required) Contact Name & Title: If different, Pricing Ordering Invoicing Remitting Returning Phone # (PO Box or Street, City, State, 9-Digit Zip Required) Contact Name & Title: Customer Service Information, if different: Phone # Fax # E-mail E-mail Address Fax # E-mail Address Fax # Use OMES_GARNVEND form for Garnishment Vendors. State Agency, fax completed and signed form to: OSF, Attention Vendor Maintenance 405-521-3383. OMES/DCAM USE ONLY: Date Posted: By: PAGE 1 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com OMES/VENDOR MAINTENANCE ­ "VENDOR/PAYEE FORM" (12/2012) SUPPLEMENTAL INFORMATION ­ ALL VENDORS OR PAYEES The information below is requested under U.S. Tax Laws. Failure to provide this information may prevent you from being able to do business with the State, or may result in the State having to deduct backup withholding amounts from its remittances to you. Federal Employer Identification Number (FEIN) U.S. Taxpayer Identification Number (TIN) U.S. Social Security Number (SSN) DUNS Number ______________________________________________________ Check the box below that best describes your residency status: Companies: Domestic (U.S.) sole proprietorship Foreign (non-U.S.) sole proprietorship* Foreign (non-U.S.) other* - explain: Individuals: Citizen (individual) of the United States Domestic (U.S.) partnership Foreign (non-U.S.) partnership* Domestic (U.S.) corporation Foreign (non-U.S.) corporation* Domestic (U.S.) other If none, but applied for, date applied If none, but applied for, date applied Resident alien (individual) of the United States Non-resident alien (individual) ** * NOTE: IF YOU MARK THIS BOX, WE WILL FORWARD AN INTERNAL REVENUE SERVICE (IRS) FORM W-8 (http://www.irs.gov/pub/irspdf/fw8ben.pdf), CERTIFICATE OF FOREIGN STATUS, TO YOU. THIS MAY EXEMPT YOU FROM BACKUP WITHHOLDING. FORM W-8 DOES NOT EXEMPT YOU FROM THE 30% (OR LOWER PERCENTAGE BY TREATY) NONRESIDENT WITHHOLDING TAXES. TO CLAIM THIS EXEMPTION, YOU MUST FILE IRS FORM 8233 WITH US. FOR MORE INFORMATION, REFER TO IRS PUBLICATION 519. SIGNATURE - AND SUBSTITUTE IRS FORM W-9 CERTIFICATION Under penalties of perjury, I certify that the above information is correct and that: 1. 2. 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 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. 3. I am a U.S. person (including a U.S. resident alien). 3. 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 real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN Signature of Vendor Representative or Individual Payee Date Title of individual signing form for company Vendor/Payee (Same as Company Name from Page 1) IRS Instructions Regarding 1099 MISC Reporting IRS Instructions regarding 1099 MISC reporting are posted on the IRS website at: http://www.irs.gov//instructions/i1099msc/index.html. Reportable payments include (a) royalties or broker payments in lieu of dividends or tax-exempt interest; (b) rents, services (including parts and materials), prizes and awards, other income payments, medical and health care payments, crop insurance proceeds, cash payments for fish (or other aquatic life) you purchase from anyone engaged in the trade or business of catching fish; (c) any fishing boat proceeds; or (d) gross proceeds paid to an attorney (see below). Generally, if reportable payments do not fall under Box 1, 2, 3, 6 or 14, use Box 7. Specifically, all payments to physicians and medical corporations must be reported in Box 6. Attorney's fees, including payments to a law firm or other provider of legal services, are reportable in Box 7, except for gross proceeds. Gross proceeds paid to attorneys, under IRC section 6045(f), are reportable in Box 14. These include the total amount paid to an attorney for settlement agreements. These rules apply whether or not the legal services are provided to the payer and whether or not the attorney is exclusive payee (e.g., the attorney's and claimant's names are on one check). Ho