19-Form 6-Substitute W-9.docx
DOCX document 31 KB Posted
- Attached to
- Ft. Worth 1st Floor Restroom Renovation
- Solicitation number
- 3202500095
- Issued by
- Tarrant County, Texas
About this file
This is a TWC Substitute W-9 and Direct Deposit Form utilized by the State of Texas, specifically the Texas Comptroller of Public Accounts, for vendor payment processing in connection with the Fort Worth 1st Floor Restroom Renovation project. The form serves as a standardized tax identification and payment authorization document required from contractors and vendors engaged with state contracts. It collects essential vendor information including legal business name, tax identification numbers (SSN or EIN), federal tax classification, business designation, and profit status. The form accommodates various business structures including corporations, sole proprietorships, partnerships, limited liability companies, and government entities. Vendors must certify under penalties of perjury that they have provided correct taxpayer identification information, are not subject to backup withholding, and are U.S. citizens or U.S. persons.
The document requires vendors to elect direct deposit authorization for state payments, with options to establish new accounts, modify existing arrangements, or decline electronic payment altogether. Vendors must provide financial institution details including routing numbers, account types, and account numbers. The form includes a certification section where authorized representatives must sign, print their names, and date the document, confirming authorization for the Texas Comptroller of Public Accounts to electronically transfer payments to the designated financial institution. The form explicitly addresses international payment considerations by requiring disclosure of whether payments will be forwarded to financial institutions outside the United States. This administrative document is essential for payment processing and compliance with state financial regulations for all vendors participating in Texas state and local contract opportunities.
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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 Partnership | F=Financial Institution | ||
| P=General Partnership | R=Foreign Corporation O=Out-of-State Corporation | U=State Agency/University S=Sole Owner | E=State Employee |
| G=Government Entity | N= 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) Page of
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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