attachment 2 Vendor Enrollment or Update Form.pdf

UNITED STATES CAPITOL POLICE

VENDOR ENROLLMENT/UPDATE

(Please Type or Print Legibly)

CP-1470

(03/13)

Instruction to USCP Financial Liaison Officer, Purchase Card Holder or Contract Specialist:

• Email this form to a vendor representative for completion of the Payee Information and Financial Institution

Information sections. Review vendor entries and reject the form if applicable fields are left blank.

• For modifications of existing vendor records, ensure the vendor highlights the changes. For any change in the vendor’s name or financial institution information, a justification is required and should be entered in block 4 and a signed and completed Form W-9 “Request for Taxpayer Identification Number and Certification” should be obtained from the vendor.

• Following your acceptance, email the fully completed form to the assigned Procurement Technician and copy the

Momentum HelpDesk. The Procurement Technician may be reached at 202-593-3547.

Instruction to Vendors: Complete all applicable form fields and return this form to the USCP requestor via reply email. If updating information previously submitted to USCP, please highlight the fields in the Payee or Financial Institution Information sections which reflect changed or corrected information.

AGENCY INFORMATION (USCP Use only)

1. EMPLOYEE REQUESTING VENDOR INFORMATION

2. TYPE OF PURCHASE (check one) Purchase Card Contract/Order Both

3. TYPE OF REQUEST New Vendor Request Modification of Existing Vendor Record

4. JUSTIFICATION

(If applicable)

PAYEE INFORMATION

5. VENDOR ENTITY NAME

6. TAXPAYER ID NUMBER EIN SSN

7. REMITTANCE ADDRESS

Check here if both the mailing address and physical address are the same as the remittance address. If not, enter additional addresses here:

MAILING ADDRESS:

PHYSICAL ADDRESS:

8. ENTITY TYPE (select one)

Corporation Partnership Sole Proprietor Limited Liability Company (LLC) - State and Local Government Federal Government Corporate Tax Classification Other (specify) Limited Liability Company (LLC) – ____________________________ Partnership Tax Classification

9. SOCIO-ECONOMIC INFO (select one or more of the following, if applicable)

Women Owned Minority Owned Small Business Other (specify) __________________

10. CONTACT PERSON NAME 11. CONTACT PHONE NUMBER

FINANCIAL INSTITUTION INFORMATION

12. FINANCIAL INSTITUTION

13. ROUTING NUMBER

14. BANK ACCOUNT NUMBER

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