17-Form 6 - Subtitute W-9 and direct deposit form.docx

DOCX document 58 KB Posted

Attached to
RFP 3202600039 CCRC Backup Generator
Solicitation number
3202600039
Issued by
Travis County, Austin City, Texas

About this file

This is a TWC Substitute W-9 and Direct Deposit Form used by the Texas Workforce Commission (TWC) for vendor payment processing and tax documentation purposes. The form requires vendors to provide their legal business name, tax identification information (either Social Security Number or Employer Identification Number), and federal tax classification designation. Vendors must also declare their business structure type, profit status, and jurisdiction of incorporation if applicable. The form accommodates various business entity types including sole proprietorships, partnerships, corporations, limited liability companies, and government entities. Additionally, the form requires vendors to declare whether they are exempt from backup withholding under IRS regulations and certify U.S. citizenship or resident alien status under penalties of perjury.

The Direct Deposit section of the form requires mandatory response from vendors regarding their payment method preferences. Vendors must either authorize electronic direct deposit to their designated financial institution or formally decline the direct deposit option. For those electing direct deposit, the form requires complete banking information including the financial institution name, routing number, account type (checking or savings), and account number. Vendors must also confirm whether payments will be forwarded to financial institutions outside the United States. The form requires authorized signature, printed name, and date certification, and grants the Texas Comptroller of Public Accounts authority to reverse any erroneous payments made to the vendor's account while ensuring compliance with National Automated Clearing House Association rules.

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Text version

TWC Substitute W-9 and Direct Deposit Form

Box 1 Box 2 Box 3 Legal Name (as shown on your tax return):

Business Name (if different from Box 1):

Tax Information Mailing Address:

City:
State:
Zip:
Phone:
Fax:
Email:
Box 4
Payment Address (if different from Tax Address):
City:
State:
Zip:
Phone:
Fax:
Email:
Box 5
Taxpayer Identification Number:
Note: Enter the same number used filing your tax return Social Security Number (SSN)

Employer Identification Number (EIN)

Box 6
Federal Tax Classification/ Business Designation:
T=Texas Corporation; C=Professional Corporation; or T/O= Limited Liability Company
A=Professional Assoc.I=Individual Recipient
L=Limited PartnershipF=Financial Institution
P=General PartnershipR=Foreign Corporation O=Out-of-State CorporationU=State Agency/University S=Sole OwnerE=State Employee
G=Government EntityN= Other

If Other, please explain:

Box 7
Profit Status:
Profit
Non-Profit
Box 8
Corporation Info:
State of Jurisdiction:
File or Charter Number:
Box 9
Sole Ownership Info:
Sole Owner Name:

Sole Owner SSN:

Box 10
General Partnership Information:
Partner 1 Name:

Partner 1 SSN/EIN:

Partner 2 Name:

Partner 2 SSN/EIN:

Box 11
Backup Withholding:

Please see IRS Website Exempt from Backup Withholding

TWC1020 (06/18)

Direct Deposit Information (Response Required)

Box 12
New Account Information (Setups and Changes)
I am currently on Direct Deposit and wish to continue.
I decline Direct Deposit at this time.
New Set-up
Change in Direct Deposit Information
Cancel My Direct Deposit

Financial Institution Name:

Financial Institution Address: City: State:

Zip:

Financial Institution Routing Number:
Type of Account:
Account Number:
Checking

Savings

Box 13
Existing Account Information (Complete only for direct deposit information change)
Financial Institution Routing Number:
Type of Account:
Account Number:
Checking

Savings

Box 14 Box 15

Will payments be forwarded to a financial institution outside the United States?
Yes
No

Certification of TWC Substitute W-9 and Direct Deposit Form

Under penalties of perjury, I certify that:

1) I have provided my correct taxpayer identification number and that;

2) I am not subject to backup withholding as specified on the instruction page for this form and that;

3) I am a US citizen or other US person and that;

4) For Direct Deposit Authorization Setup, Changes or Cancellation I authorize the Texas Comptroller of Public Accounts to deposit my payments from the State of Texas to my financial institution electronically. I understand that the Texas Comptroller of Public Accounts will reverse any payments to my account in error.

I further understand that the Texas Comptroller of Public Accounts will comply at all times with the National Automated Clearing House Association’s rules. For further information on these rules, please contact your financial institution.

Authorized Signature Required:

Printed Name Required: Date Required:

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