ESBD_473696_1765227198469_Form 6 - Subtitute W-9 and direct deposit form.docx

DOCX document 58 KB Posted

Attached to
CCRC Backup Generator
Solicitation number
3202600039
Issued by
Travis County, Austin City, Texas

About this file

This is a TWC Substitute W-9 and Direct Deposit Form required by the Texas Comptroller of Public Accounts for payment processing related to state contract opportunities in Texas. The form serves as a standardized submission document for contractors and vendors to provide essential tax identification and payment distribution information. The document requires completion of multiple information sections including legal name, business designation, tax identification numbers, and federal tax classification. Contractors must certify their taxpayer identification information, confirm they are not subject to backup withholding, and affirm their status as a U.S. citizen or other U.S. person. The form does not specify particular products, services, quantities, response dates, site visits, bidder meetings, award dates, or contract terms, as it functions solely as an administrative prerequisite form for financial processing rather than as a substantive contract solicitation document.

The form mandates a response regarding direct deposit enrollment, requiring vendors to either continue existing direct deposit arrangements, establish new accounts, modify current account information, or decline electronic payment altogether. Vendors must provide complete financial institution details including routing numbers and account information if selecting direct deposit as their payment method. The form addresses international payment considerations by requiring disclosure if payments will be forwarded to financial institutions outside the United States. Authorization requires an original signature, printed name, and date from the contractor. This form represents a standard administrative requirement for all state contractors in Texas and contains no pricing terms, set-asides, incumbent information, or funding details specific to individual contracts.

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Text version

TWC Substitute W-9 and Direct Deposit Form

Box 1 Box 2 Box 3 Legal Name (as shown on your tax return):

Business Name (if different from Box 1):

Tax Information Mailing Address:

City:
State:
Zip:
Phone:
Fax:
Email:
Box 4
Payment Address (if different from Tax Address):
City:
State:
Zip:
Phone:
Fax:
Email:
Box 5
Taxpayer Identification Number:
Note: Enter the same number used filing your tax return Social Security Number (SSN)

Employer Identification Number (EIN)

Box 6
Federal Tax Classification/ Business Designation:
T=Texas Corporation; C=Professional Corporation; or T/O= Limited Liability Company
A=Professional Assoc.I=Individual Recipient
L=Limited PartnershipF=Financial Institution
P=General PartnershipR=Foreign Corporation O=Out-of-State CorporationU=State Agency/University S=Sole OwnerE=State Employee
G=Government EntityN= Other

If Other, please explain:

Box 7
Profit Status:
Profit
Non-Profit
Box 8
Corporation Info:
State of Jurisdiction:
File or Charter Number:
Box 9
Sole Ownership Info:
Sole Owner Name:

Sole Owner SSN:

Box 10
General Partnership Information:
Partner 1 Name:

Partner 1 SSN/EIN:

Partner 2 Name:

Partner 2 SSN/EIN:

Box 11
Backup Withholding:

Please see IRS Website Exempt from Backup Withholding

TWC1020 (06/18)

Direct Deposit Information (Response Required)

Box 12
New Account Information (Setups and Changes)
I am currently on Direct Deposit and wish to continue.
I decline Direct Deposit at this time.
New Set-up
Change in Direct Deposit Information
Cancel My Direct Deposit

Financial Institution Name:

Financial Institution Address: City: State:

Zip:

Financial Institution Routing Number:
Type of Account:
Account Number:
Checking

Savings

Box 13
Existing Account Information (Complete only for direct deposit information change)
Financial Institution Routing Number:
Type of Account:
Account Number:
Checking

Savings

Box 14 Box 15

Will payments be forwarded to a financial institution outside the United States?
Yes
No

Certification of TWC Substitute W-9 and Direct Deposit Form

Under penalties of perjury, I certify that:

1) I have provided my correct taxpayer identification number and that;

2) I am not subject to backup withholding as specified on the instruction page for this form and that;

3) I am a US citizen or other US person and that;

4) For Direct Deposit Authorization Setup, Changes or Cancellation I authorize the Texas Comptroller of Public Accounts to deposit my payments from the State of Texas to my financial institution electronically. I understand that the Texas Comptroller of Public Accounts will reverse any payments to my account in error.

I further understand that the Texas Comptroller of Public Accounts will comply at all times with the National Automated Clearing House Association’s rules. For further information on these rules, please contact your financial institution.

Authorized Signature Required:

Printed Name Required: Date Required:

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