ESBD_474660_1767973625174_Form 6-Substitute W-9.docx
DOCX document 31 KB Posted
- Attached to
- Fort Worth 1st Floor Restroom Renovation
- Solicitation number
- 3202600095
- Issued by
- Tarrant County, Texas
About this file
This is a Substitute W-9 and Direct Deposit Form issued by the Texas Workforce Commission (TWC) for state of Texas payment processing. The form serves as a standardized document for collecting essential taxpayer identification information and direct deposit authorization from vendors, contractors, and other payees doing business with the State of Texas. The document requires completion of multiple information sections including legal name, business designation, taxpayer identification number (either Social Security Number or Employer Identification Number), federal tax classification, and business structure details. Respondents must designate their profit or non-profit status and provide jurisdiction and charter information for corporations or partnership details as applicable.
The form requires mandatory responses regarding direct deposit participation, with options to establish new accounts, modify existing arrangements, cancel services, or decline direct deposit altogether. Financial institution details including routing numbers, account types, and account numbers must be provided for those electing direct deposit. The form includes certification statements requiring authorized signatures affirming the accuracy of taxpayer identification information, confirmation of U.S. citizenship or residency status, and authorization for the Texas Comptroller of Public Accounts to electronically deposit state payments. Respondents must also indicate whether payments will be forwarded to financial institutions outside the United States.
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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 Partnership | F=Financial Institution | ||
| P=General Partnership | R=Foreign Corporation O=Out-of-State Corporation | U=State Agency/University S=Sole Owner | E=State Employee |
| G=Government Entity | N= 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) Page of
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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