Attachment 3 Vendor Enrollment or Update Form 02-18.pdf

UNITED STATES CAPITOL POLICE

VENDOR ENROLLMENT/UPDATE

THIS FORM MUST BE TYPED

CP-1470

(02/18)

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

• Complete the Agency Information section and email this form to a vendor representative for completion of the Payee

Information section.

• Upon receipt from a vendor, review entries in the Payee Information section and do not accept the form if there is a discrepancy or applicable fields are left blank.

• For any changes to an existing vendor record, enter the reason or explanation in Block 5.

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

Procurement Analyst and Momentum HelpDesk.

Instruction to Vendors:

• Complete all applicable fields in the Payee Information section (form fields must be typed).

• Highlight in yellow any form fields that display a change or correction of previously submitted information.

• If you select LLC in Block 10, you must attach a completed and signed Form W-9 Request for Taxpayer Identification Number and Certification.

• Save the form as a PDF file, and attach it to your reply to the USCP requestor’s email.

AGENCY INFORMATION (USCP Use only)

1. EMPLOYEE REQUESTING VENDOR INFORMATION 2. DATE OF REQUEST

3. TYPE OF PURCHASE (check one) Purchase Card Contract/Order Both Other ________________

4. TYPE OF REQUEST New Vendor Record Modification of Existing Vendor Record

5. JUSTIFICATION

(If applicable)

PAYEE INFORMATION

6. VENDOR ENTITY NAME

7. TAXPAYER ID NUMBER EIN SSN

8. DUNS NUMBER

9a. REMITTANCE ADDRESS

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

9b. MAILING ADDRESS 9c. PHYSICAL ADDRESS

10. ENTITY TYPE (select one)

Corporation Sole Proprietor

Limited Liability Company (LLC) - Federal Government - Must attach a signed Form W-9 Agency Location Code (ALC) _________________________ Partnership Treasury Account Symbol (TAS) ________________________

State and Local Government Other _______________________________________________

11. IS VENDOR ENTITY CURRENTLY REGISTERED WITH THE INVOICE

PROCESSING PLATFORM (IPP)?

YES NO

12. ACCOUNTS RECEIVABLE CONTACT

NAME OR IPP USER

13. CONTACT PHONE

NUMBER

14. CONTACT EMAIL

15. BANK ROUTING NUMBER

16. BANK ACCOUNT NUMBER