Vendor Authorization Request Template 1.2025.pdf

Vendor Authorization Request - Domestic Instructions PAGE 1

For ASRC Federal and Subsidiary Vendors ONLY

Instructions For General Instructions refer to the IRS Form W-9 located on the IRS website (www.irs.gov).

ASRC Federal defaults to Net 45 payment terms for large business and Net 30 for small business, unless stated otherwise in the sales contract/purchase order.

ASRC Federal and its Subsidiaries (ASRC) may award procurement to the seller where the costs will be charged to a U.S. government prime or subcontract.

If so, the seller is advised that the U.S. government may impose a penalty against a firm misrepresenting its business size and/or disadvantaged status for the purposes of obtaining procurement that is to be included as part, or all of a goal contained in ASRC’s Subcontracting plan. Eligibility as a small business is based on the regulations issued by the Small Business Administration in CFR 13, Part 121 of the SBA Rules and Regulations and FAR 52.219-1.

Electronic Payments ASRC Federal has partnered with Corpay Payment Automation to facilitate electronic payments to our Vendors. To receive electronic payments, you must enroll with Corpay Payment Automation Note: You are required to receive one paper check prior to enrolling in Corpay Payment Automation

Section 1 - Taxpayer Identification

1. Taxpayer Identification Type. Check the type of identification number provided in box 2.

2. Taxpayer Identification Number (TIN). Enter taxpayer's nine-digit Employer Identification Number (EIN), Social Security Number (SSN), or individual

Taxpayer Identification Number (TIN) without dashes.

Note: If an LLC has an owner, the LLC's default tax status is "disregarded entity". If an LLC has two owners, the LLC's default tax status is "partnership". If an LLC has elected to be taxed as a corporation, it must file IRS Form 2553 (S Corporation) or IRS Form 8832 (C Corporation).

3. Legal Name. Enter the legal name as registered with the IRS or Social Security Administration. In general, enter the name shown on your income tax return. Do not enter a Disregarded Entry Name on this line.

4. Business Name. Business, Disregarded Entity, trade, or DBA ("doing business as") name.

5. Identifiers. Vendors are requested to enter their UEI number, DUNS number, and CAGE code if applicable.

Contact Information

6. Enter your Legal Address.

7. Enter your Remittance Address, if applicable. A Remittance Address is the location in which you or your entity receives business payments.

Note: This address should match the remittance address on your invoices.

8. Enter the Contact Name.

9. Enter your Business Phone Number.

10. Enter your Fax Number, if applicable.

11. Enter your Email Address, if applicable.

For clarification on IRS Guidelines, see www.irs.gov.

12. Entity Type. Select the appropriate entity type.

13. Entity Classification. Select the appropriate classification type.

14. Business Size. Select the appropriate business size

15. Business Classification. Check any classification that applies to your business as defined in Federal Acquisitions Regulations (FAR) 19.1.

Exemptions You may be exempt from backup withholding and/or FATCA reporting. See Exempt payee code and Exemption from FATCA reporting code below. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

Note: If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding.

The following codes identify payees that are exempt from backup withholding:

1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2).

2. The United States or any of its agencies or instrumentalities.

3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities.

4. A foreign government or any of its political subdivisions, agencies, or instrumentalities.

5. A corporation.

6. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States.

7. A futures commission merchant registered with the Commodity Futures Trading Commission.

8. A real estate investment trust.

9. An entity registered at all times during the tax year under the Investment Company Act of 1940.

10. A common trust fund operated by a bank under section 584(a).

11. A financial institution.

12. A middleman known in the investment community as a nominee or custodian.

13. A trust exempt from tax under section 664 or described in section 4947.

Version 1.0 Vendor Authorization Request – Domestic

Vendor Authorization Request - Domestic Instructions PAGE 2

For ASRC Federal and Subsidiary Vendors ONLY

The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

If the payment is for... THEN the payment is exempt for...

Interest and dividend payments All exempt payees except for 7

Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.

Barter exchange transactions and patronage dividends Exempt payees 1 through 4

Payments over $600 required to be reported and direct sales over

$50001 Generally, exempt payees 1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous income and Form 1099-NEC, Nonemployee Compensation and their instructions.

2 However, the following payments made to a corporation and reportable on Form 1099-MISC or Form 1099-NEC are not exempt from backup withholding:

medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial instructions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements.

A. An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37).

B. The United States or any of its agencies or instrumentalities.

C. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities.

D. A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg. section 1.1472-1(c)(1)(i).

E. A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i).

F. A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state. G. A real estate investment trust.

H. A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940.

I. A common trust fund as defined in section 584(a).

J. A bank as defined in section 581.

K. A broker.

L. A trust exempt from tax under section 664 or described in section 4947(a)(1).

M. A tax exempt trust under a section 403(b) plan or section 457(g) plan.

Section 2 - Contact Enter your contact information (department name, point of contact name, email address and phone number) for payment remittance and inquiries.

Section 3 - Certification To establish to the paying agency that your TIN is correct, you are not subject to backup withholding, or you are a U.S. person, or resident alien, sign the certification on the Vendor Authorization Request. You are required to sign using a certified digital signature or wet ink only.

For additional information, refer to the IRS Form W-9 located on the IRS website (www.irs.gov).

Version 1.0 Vendor Authorization Request - Domestic

IRS Form W-9 is not required but may be attached in addition to this form.

*Denotes a Required Field

VENDOR AUTHORIZATION REQUEST - DOMESTIC

New Vendors and Reactivations

For ASRC Federal and Subsidiar Vendors ONLY

Se ct io n

Ta xp ay er Id en tif ic at io n

Select the appropriate Taxpayer Identification Number (EIN, SSN, or ITIN) type and enter your 9-digit ID number. The U.S. Taxpayer Identification Number is being requested per U.S. Tax Law. Failure to provide this information in a timely manner could prevent or delay payment to you or require the Withholding Agent to withhold 24% for backup withholding tax.

* 1. Taxpayer Identification Number Type (select one) Social Security Number (SSN) Employer Identification Number (EIN) Individual Taxpayer Identification Number (ITIN)

* 2. Taxpayer Identification Number (no dashes)

* 3. Legal Name (as shown on your income tax return) 5. Identifiers Unique Entity Identifier (UEI) number:

Commercial and Govt Entity (CAGE) code:

Dunn & Bradstreet Universal Numbering System (DUNS) (see instructions):

4. Business Name/DBA/Disregarded Entity Name

Contact Information (a physical address is required)

* 6. Legal Address / Physical Address 7. Remittance / Payment Address (as printed on invoice)

Address Line 1 Address Line 1

Address Line 2 Address Line 2

City, State Zip (9 digit) City, State Zip (9 digit)

* 8. Contact Name * 9. Phone Number * 10. Fax Number * 11. Email Address

* 12. Entity Type (select one) * 13. Entity Classification Individual/Sole Proprietor/Single-member LLC C-Corporation S-Corporation Partnership Trust/Estate Other LLC: Enter the classification (C=C corp, S=S corp, P=Partnership)

Note: Do not check LLC if the LLC is classified as a single member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Legal/Atty Services Medical Services Government Other:

15. Business Classifications SBA Certified Disadvantaged Business (SDB) 8(a) Certified HUBZone Certified Woman-Owned Small Business (WOSB) Veteran-Owned Business Service-Disabled Veteran-Owned Historically Black Colleges and Universities

(HBCU)

Alaskan Native Corporations

* 14. Business Size (select one) Small Business Large Business Foreign Owned

Non-Profit Other (Specify)

Contact Information for Payment Remittance and Inquiries

* Department Name * Contact Name

* Contact Email Address * Contact Phone Number

Se ct io n

- C er tif ic at io n

Under penalties of perjury, I certify that

1. 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

2. 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 because 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, and

3. I am a U.S. citizen or other U.S. person (defined in general instructions), and

4. The FACTA code(s) entered on this form (if any) indicating that I am exempt from FACTA reporting is correct. For certification instructions refer to the IRS Form W-9 located on the IRS website (www.irs.gov) The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

* Name * Title

* Authorized Signature * Date

Complete "Modification to Existing Vendor Records" (PAGE 4) if there have been changes to your existing vendor information.

Version 1.0 Vendor Authorization Request - Domestic