Supplier_Information_Form.pdf

See attached instructions. Information with asterisks (*) are mandatory.

Supplier Information Form

Board of Governors of the Federal Reserve System *Doing Business With:

Federal Reserve Board (FRB) Federal Financial Institutions Examination Council (FFIEC)

E-mail the completed form to Board-Vendors@frb.gov. For inquiries, contact 202-452-2481.

05/2018FR 03-300-01 Page 1 of 2

Service-disabled Veteran-owned

Country

A. *Name (Enter Name as shown on Income Tax Return – if taxable; see section II-B.)

B. Business Name/Doing-Business-As (DBA) Name (if different from above)

Street Address 1

Street Address 2 City

Province

Apartment/Suite/Unit

Zip/Postal Code

C. *Identification Number:

A. *Primary Contact

D. *Address:

VI. *AUTHORIZATION

Name

Phone Fax

Section/Department/Division

Title

Name

Phone Fax

Section/Department/Division

Title

B. Secondary Contact C. *Preferred e-mail address to receive Notice of Payment

Same as in A Same as in B Other (Specify below)

B. Size of Business Small Large

D. *How did you meet the Board?

Advocacy Group (Specify below)

Other (Specify below)

Outreach Event (Specify below)

A. Location of Registered Office Within U.S. (local) Outside U.S. (foreign)

I authorize the Board of Governors of the Federal Reserve System to make payments using the information provided above. I will notify the Board as soon as possible if the above information changes.

V. *MODE OF PAYMENT

IV. SUPPLIER CLASSIFICATION (Only applies to taxable suppliers; select all that apply.)

III. CONTACT INFORMATION

I. GENERAL INFORMATION

Electronic Funds Transfer (EFT) (Default mode of payment; only applies to suppliers with U.S. bank acccounts.)

Wire (Only applies to foreign corporation or foreign speakers; foreign beneficiary bank must have a U.S. correspondent bank that will accept payment and forward to the foreign beneficiary bank.)

Check

SavingsCheckingAccount Type:

Foreign Beneficary Bank:

U.S. Correspondent Bank:

ACH 9-digit Routing/ABA Number Account Number

Account Number

SWIFT/BIC Name/Address

Name/Address

TitleName

C. Ownership Minority-owned

African American Asian

Veteran-owned Women-owned

American Indian or Alaska Native

Hispanic or Latino Pacific Islander Native Hawaiian

Sole Proprietorship Speaker (Paid for service fees.)

Other (Specify below)

Applicant Government Agency Speaker (Paid for travel expenses only.)

System Interchange Participant (FRS)

A. Non-taxable (Skip section IV.)

Corporation

Limited Liability Corporation (LLC) S Corporation

Educational Institution Individual Non-profit Organization Partnership

B. Taxable (Attach tax forms; see Instructions for details.)

Specify (if appropriate):

II. *SUPPLIER TYPE (Select only one.)

EmailEmail

International Bank Account Number (IBAN) or Clave Bancaria Estandarizada (CLABE) (as applicable)

ACH 9-digit Routing/ABA Number

• Only used if EFT or U.S. Correspondent Bank on wire payments to foreign corporation or speakers is not available; must provide valid requirement on why check is requested and must be approved by the Board.

• Check will be mailed to the address provided in Section I-D.

• For foreign suppliers, check cashing fees with foreign banks will NOT be included in the payment unless negotiated per the contract.

State

Social Security Number (SSN) Taxpayer Identification Number (TIN) D&B Data Universal Numbering System (DUNS) Number

For Internal Use Only: Create E2 Profile

Signature Date (mm/dd/yyyy)

Supplier Information Form—Instructions

FR 03-300-01 05/2018Page 2 of 2

NOTE: Information with asterisks (*) are mandatory

Section I. General Information

A. If supplier's income is taxable, enter the name as it appears on supplier's tax form. See Section II-B.

B. This is the supplier's registered business or Doing-Business-As (DBA) name, if different from A. This only applies to suppliers with taxable income.

C. This is the supplier's U.S.

taxpayer identification number.

Some suppliers may also provide their Dun & Bradstreet (D&B) Data Universal Numbering System (DUNS) Number in addition to taxpayer identification number.

D. This is the supplier's remittance address which is also used as the check payment address.

Section II. Supplier Type

A. Non-taxable suppliers are suppliers whose income are not taxable.

B. Taxable suppliers are suppliers whose income are taxable.

Local suppliers must submit Internal Revenue Service (IRS) Form W-9 (http://www.irs.gov/pub/irs-pdf/ fw9.pdf). If supplier is already in the system and had previously submitted the form, submission of another form is not required unless updating information.

Foreign individual suppliers must submit IRS Form W-8BEN and Form 8233 (http://www.irs.gov/Forms-&- Pubs). However, foreign individuals who provided personal services only (for example, speaker providing services) must only submit Form 8233.

Section V. Mode of Payment

► Electronic Funds Transfer (EFT) is the default mode of payment.

Indicate the account type if it is savings or checking. Enter the ACH 9-digit routing or ABA number and account number.

► Wire payment is only applicable to foreign corporations or foreign speakers. The Board will not make a wire payment directly to a foreign beneficiary bank. The foreign beneficiary bank used for wire payment must have a U.S.

correspondent bank that will accept payment and forward to the foreign beneficiary bank in order to process this. Enter the account number and International Bank Account Number (IBAN). Enter foreign beneficiary bank's Society for Worldwide Interbank Financial Telecommunication (SWIFT) and/or Bank Identifier Code (BIC), name, and address. Enter U.S.

correspondent bank's ACH 9-digit routing/ABA number, name, and address.

► Check is only used if EFT is not available. The supplier must provide valid requirement on why check is requested. The request will be reviewed by the Board and check will be processed upon approval. Check will be mailed to the address provided in Section I-D. For foreign suppliers, check cashing fees with foreign banks will NOT be included in the payment unless negotiated per the contract.

Section VI. Authorization

Sign the form (either wet or electronic), and enter name, title of signee and date of signature.

E-mail the completed form to Board-Vendors@frb.gov.

For inquiries, contact 202-452-2481.

Other foreign suppliers (not individuals) must submit appropriate IRS Form(s) (e.g., W-8BEN-E, W-8CE, W-8ECI, W-8EXP, W-8IMY, or others) (http://www.irs.gov/Forms- &-Pubs).

Foreign suppliers are required to submit tax form(s) every tax year.

Without these forms, the Board is required to withhold 30% taxes from foreign suppliers compensation payments. It is the supplier's responsibility to review and complete these forms to determine whether or not a tax treaty exists between U.S. and the supplier's country and to determine whether or not the supplier is exempt from taxes.

Section III. Contact Information

A., B. Enter primary contact, and enter secondary if available.

C. Notice of payment is sent through e-mail so it is mandatory that the supplier provide an e-mail address either from A,B, or specified that is appropriate to send the notice.

Section IV. Supplier Classification

A. Indicate location of supplier's registered office, if it is local (within U.S.) or foreign (outside U.S.).

B. Indicate size of business. For details on Small Business Size Standards, go to https://www.sba.gov/category/ navigation-structure/contracting/ contracting-officials/small-business-size-standards

C. Indicate ownership of business, if it is minority-, service-disabled veteran-, veteran-, or women-owned.

D. Indicate how the supplier met the Board.

http://www.irs.gov/pub/irs-pdf/fw9.pdf http://www.irs.gov/pub/irs-pdf/fw9.pdf http://www.irs.gov/Forms-&-Pubs http://www.irs.gov/Forms-&-Pubs mailto:Board-Vendors@frb.gov?subject=Federal%20Reserve%20Board%20Supplier%20Information%20Form http://www.irs.gov/Forms-&-Pubs http://www.irs.gov/Forms-&-Pubs https://www.sba.gov/category/navigation-structure/contracting/contracting-officials/small-business-size-standards https://www.sba.gov/category/navigation-structure/contracting/contracting-officials/small-business-size-standards https://www.sba.gov/category/navigation-structure/contracting/contracting-officials/small-business-size-standards https://www.sba.gov/category/navigation-structure/contracting/contracting-officials/small-business-size-standards

.\SEALBLK.TIF

Seal of Board of Governors of the Federal Reserve System.

See attached instructions. Information with asterisks (*) are mandatory.

Supplier Information Form Board of Governors of the Federal Reserve System *Doing Business With:

E-mail the completed form to Board-Vendors@frb.gov. For inquiries, contact 202-452-2481.

05/2018

FR 03-300-01

Supplier Information Form—Instructions

FR 03-300-01

05/2018 9.0.0.2.20120627.2.874785 Supplier Information—FR 03-100-01 Federal Reserve Board Supplier Information—FR 03-100-01 PCS Information Solutions C. *Identification Number:

A. *Primary Contact D. *Address:

VI. *AUTHORIZATION

B. Secondary Contact C. *Preferred e-mail address to receive Notice of Payment B. Size of Business D. *How did you meet the Board?

A. Location of Registered Office I authorize the Board of Governors of the Federal Reserve System to make payments using the information provided above. I will notify the Board as soon as possible if the above information changes.

V. *MODE OF PAYMENT

IV. SUPPLIER CLASSIFICATION (Only applies to taxable suppliers; select all that apply.)

III. CONTACT INFORMATION

I. GENERAL INFORMATION

Account Type:

Foreign Beneficary Bank:

U.S. Correspondent Bank:

Title Name C. Ownership A. Non-taxable (Skip section IV.)

B. Taxable (Attach tax forms; see Instructions for details.)

Specify (if appropriate):

II. *SUPPLIER TYPE (Select only one.)

International Bank Account Number (IBAN) or Clave Bancaria Estandarizada (CLABE) (as applicable)

• Only used if EFT or U.S. Correspondent Bank on wire payments to foreign corporation or speakers is not available; must provide valid requirement on why check is requested and must be approved by the Board.

• Check will be mailed to the address provided in Section I-D.

• For foreign suppliers, check cashing fees with foreign banks will NOT be included in the payment unless negotiated per the contract.

For Internal Use Only:

Signature Date (mm/dd/yyyy) NOTE: Information with asterisks (*) are mandatory Section I. General Information A. If supplier's income is taxable, enter the name as it appears on supplier's tax form. See Section II-B.

B. This is the supplier's registered business or Doing-Business-As (DBA) name, if different from A. This only applies to suppliers with taxable income.

C. This is the supplier's U.S. taxpayer identification number. Some suppliers may also provide their Dun & Bradstreet (D&B) Data Universal Numbering System (DUNS) Number in addition to taxpayer identification number.

D. This is the supplier's remittance address which is also used as the check payment address.

Section II. Supplier Type A. Non-taxable suppliers are suppliers whose income are not taxable.

B. Taxable suppliers are suppliers whose income are taxable.

Local suppliers must submit Internal Revenue Service (IRS) Form W-9 (http://www.irs.gov/pub/irs-pdf/fw9.pdf). If supplier is already in the system and had previously submitted the form, submission of another form is not required unless updating information.

Foreign individual suppliers must submit IRS Form W-8BEN and Form 8233 (http://www.irs.gov/Forms-&-Pubs). However, foreign individuals who provided personal services only (for example, speaker providing services) must only submit Form 8233.

Section V. Mode of Payment ► Electronic Funds Transfer (EFT) is the default mode of payment. Indicate the account type if it is savings or checking. Enter the ACH 9-digit routing or ABA number and account number.

► Wire payment is only applicable to foreign corporations or foreign speakers. The Board will not make a wire payment directly to a foreign beneficiary bank. The foreign beneficiary bank used for wire payment must have a U.S. correspondent bank that will accept payment and forward to the foreign beneficiary bank in order to process this. Enter the account number and International Bank Account Number (IBAN). Enter foreign beneficiary bank's Society for Worldwide Interbank Financial Telecommunication (SWIFT) and/or Bank Identifier Code (BIC), name, and address. Enter U.S. correspondent bank's ACH 9-digit routing/ABA number, name, and address.

► Check is only used if EFT is not available. The supplier must provide valid requirement on why check is requested. The request will be reviewed by the Board and check will be processed upon approval. Check will be mailed to the address provided in Section I-D. For foreign suppliers, check cashing fees with foreign banks will NOT be included in the payment unless negotiated per the contract.

Section VI. Authorization Sign the form (either wet or electronic), and enter name, title of signee and date of signature.

E-mail the completed form to Board-Vendors@frb.gov.

For inquiries, contact 202-452-2481.

Other foreign suppliers (not individuals) must submit appropriate IRS Form(s) (e.g., W-8BEN-E, W-8CE, W-8ECI, W-8EXP, W-8IMY, or others) (http://www.irs.gov/Forms-&-Pubs).

Foreign suppliers are required to submit tax form(s) every tax year. Without these forms, the Board is required to withhold 30% taxes from foreign suppliers compensation payments. It is the supplier's responsibility to review and complete these forms to determine whether or not a tax treaty exists between U.S. and the supplier's country and to determine whether or not the supplier is exempt from taxes.

Section III. Contact Information A., B. Enter primary contact, and enter secondary if available.

C. Notice of payment is sent through e-mail so it is mandatory that the supplier provide an e-mail address either from A,B, or specified that is appropriate to send the notice.

Section IV. Supplier Classification A. Indicate location of supplier's registered office, if it is local (within U.S.) or foreign (outside U.S.).

B. Indicate size of business. For details on Small Business Size Standards, go to https://www.sba.gov/category/navigation-structure/contracting/contracting-officials/small-business-size-standards C. Indicate ownership of business, if it is minority-, service-disabled veteran-, veteran-, or women-owned.

D. Indicate how the supplier met the Board.

null