Vendor Information Packet

CBU Department Contact

(Please list the primary CBU employee or department you will be working with.)
Name
Email
Name of Individual or Business Name

(If sole proprietor, please list name of owner and name of business.)
Name
Social Security Number or EIN

If you are a sole proprietor, please provide the SSN or EIN to correspond with your invoices.

If you are choosing to be paid as an individual, provide SSN; if you are choosing to be paid to your business, provide EIN.
Individual or Business?

Individual or Business? Individual Business
Individual Classification
Individuals: Please check the appropriate classification

Individuals: Please check the appropriate classification U.S. Citizen - U.S. citizens must attach W-9. Resident Alien - Resident aliens must provide a copy of their Permanent Resident Card when submitting this form Non-Resident Alien Non-resident aliens must attach W-8 BEN.
Upload W-9, Permanent Resident Card, or W-8 BEN

Attach Files
Business Classification
Business: Please check the appropriate classification.

Business: Please check the appropriate classification. U.S. Company U.S. companies must attach W-9. Foreign Vendor with US Presence Foreign Vendors with US Presence must attach W-8 ECI Foreign Vendor Foreign Vendors must attach W-8 BEN or W-8 EXP as appropriate
Upload W-9, W-8 ECI, W-8 BEN, or W-8 EXP

Attach Files
Permanent Residence/Corporate Office Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Fax Fax - ### - ### ####
Email
Payment Address
Is your payment address the same as above?

Is your payment address the same as above? Yes No
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Payment Phone Payment Phone - ### - ### ####
Payment Fax Payment Fax - ### - ### ####
Payment Email
The following methods of payment will be accepted (check all that apply):

The following methods of payment will be accepted (check all that apply): Credit Card ACH/Direct Deposit Check
Notice

You will be redirected to the ACH/Direct Deposit enrollment form after submission.
The following discount is given for early payment:
Vendor Information
Types of Goods and Services Provided
Vendor Classification: Please check all that apply.

Vendor Classification: Please check all that apply. None of These Alumni-Owned In-County Employee-Owned Minority-Owned Women-Owned Small Business State Contract Veteran-Owned
Certification and Signature

Vendor Signature (This form is not considered valid unless signed and dated)
Printed name Printed name First Last
Phone Phone - ### - ### ####
Email
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Vendor Information Packet

Vendor Information Packet

CBU Department Contact

Name of Individual or Business Name

Individual Classification

Business Classification

Permanent Residence/Corporate Office Address

Payment Address

Notice

Vendor Information

Certification and Signature