ESBD_481805_1767978045505_Form 6- Substitute W-9 and Direct Deposit Form.docx
DOCX document 39 KB Posted
- Attached to
- Trinity Landscape Services
- Solicitation number
- 3202600118
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Texas Comptroller of Public Accounts Substitute W-9 and Direct Deposit Form used by the State of Texas for vendor payment processing and financial account management. The form collects essential vendor information including legal name, business designation, tax identification numbers (SSN or EIN), and business classification across multiple entity types such as corporations, partnerships, sole proprietorships, and government entities. The document requires vendors to provide their tax information mailing address and an alternative payment address if applicable, along with business structure details including state of jurisdiction and charter numbers for corporations or partner information for partnerships.
The form mandates direct deposit enrollment as a condition of payment, with vendors required to select from options including new account setup, continuation of existing direct deposit, changes to account information, or cancellation of services. Vendors must provide complete financial institution details including routing number, account type (checking or savings), and account number, and must certify authorization for the Texas Comptroller of Public Accounts to electronically deposit state payments. The form includes provisions for backup withholding exemption status and addresses international banking considerations, requiring vendors to confirm whether payments will be forwarded to financial institutions outside the United States. All vendor certifications require authorized signatures, printed names, and dates acknowledging U.S. citizenship or person status and compliance with National Automated Clearing House Association rules.
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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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