Attachment Two.pdf

UNITED STATES CAPITOL POLICE

VENDOR ENROLLMENT/UPDATE

THIS FORM MUST BE TYPED

CP-1470

(06/16)

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

• For changes in the vendor’s name, a justification must be entered in block 5 and a signed Form W-9 “Request for Taxpayer Identification Number and Certification” should be obtained from the vendor.

• For changes to the vendor’s financial institution information, an explanation must be entered in block 5.

• Following your acceptance, email the fully completed form to the assigned Procurement Technician and copy the Momentum HelpDesk. The currently assigned Procurement Technician may be reached at 202-593-3547.

Instruction to Vendors: Complete all applicable fields in the Payee Information section. Highlight fields where your entry changes or corrects previously submitted information. 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 Partnership Sole Proprietor Limited Liability Company (LLC) - State and Local Government Other ______________ Corporate Tax Classification Federal Government - Limited Liability Company (LLC) - Agency Location Code (ALC) _________________________ Partnership Tax Classification Treasury Account Symbol (TAS) ________________________

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