ESBD_487724_1770386165702_Exhibit J.3 - Texas A&M Substitute W-9 & ACH Form.pdf

Substitute W9 & Vendor Direct Deposit Form

Transaction Type: For TAMUS Use Only: Buy A&M: Concur: Funds:

Payee Information:

Individual/Company/Entity Legal Name:

(Must match TIN below):

Taxpayer ID #: or

Federal Tax I.D Number SSN ‐ Individual/Sole Proprietor

DBA Name (If Applicable):

Vendor Type - Select all that apply:

Individual/Sole Proprietorship C ‐ Corporation S ‐ Corporation Partnership Trust/Estate Other

Limited Liability Company. Enter the tax classification (C = C corporation, S = S corporation, P = partnership)

Exempt payee code (if any) Exemption from FATCA reporting code (if any)

Vendor Contact Information:

Name: (Print Name) Phone:

Please Provide an Email For Orders: Email:

Vendor/Individual Remit To Address: Order Address ( For Business Entities Only):

Address: Address:

City: State: City: State:

Zip:

Zip:

Certification: Under Penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt form backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no long subject to backup withholding, and

3. I am a US citizen or other US person (defined below), and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct

Certification Instructions: You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you failed to report all interest & dividends on your tax return. For real estate transactions, item 2 does not apply.

Direct Deposit Setup Information-Please fill out all fields to receive direct deposit.

Will these payments be forwarded to a financial institution outside the U.S.? Yes No Acct Type: Checking Savings

Bank Name: Email for ACH Notification:

ABA Routing Number: Account Number:

Pursuant to Section 403.016, Texas government Code, I authorize the Comptroller of Public Accounts and/or applicable financial institution as designated by Texas A&M University System Members to deposit by electronic transfer payments owed to me by the State of Texas and if necessary, reversal entries and adjustments for any amounts deposited electronically in error. The Comptroller shall deposit the payments in the financial institution & account designated below. I recognize that if I fail to provide complete & accurate information on this the processing authorization form, of the form may be delayed or that my payments may be erroneously transferred electronically. I consent to & agree to comply with the National Automated Clearing House Association Rules & Regulations & the Comptroller’s rules about electronic transfers as they exist on the date of my signature on this form or as subsequently adopted, amended or repealed.

Print Name: Signature: Date:

Please mail or fax to Texas A&M University, FMO‐AP, TAMU MS 6000, College Station, TX 77843‐6000; (979) 458‐4191;

For questions email vendorhelp@tamu.edu (Rec 09/2015)

Instructions for Substitute W9 & Direct Deposit Form

Do not use this Substitute W9 form if you are a Foreign Individual or Entity.

Vendors that are a Foreign Alien or Entity will need to complete one of the W8’s at the following web link Vendor Setup .

Instructions for completing this form Under IRS reporting requirements we are required to obtain the Social Security Number or Employee

Identification Number. If this is not provided, your payments may be subject to 28% federal income tax backup withholding.

Domestic Vendors that meet the following must complete this Substitute W‐9 Form:

New or updating information for Texas A&M University System Members You are a U.S. entity or an individual (including a resident alien) If you would like to fill out the Standard IRS W9 form, you must include the Vendor Information Sheet when submitting your W9 for PO Distribution.

Vendors must complete all sections of this form (ACH optional, but strongly encouraged).

Select New Request or Update. If Update, please fill in Vendor ID Number if known.

Enter your entity's Legal Name as found on your IRS documents and the corresponding Taxpayer ID Number.

If operating as a DBA, enter the name in the DBA field, otherwise leave blank.

Enter your entity's Contact Information.

Select all that apply for the Vendor Type.

Enter your entity's Remit to Address and Order Address.

If the Remit to Address & the Order Address are the same just fill out the Remit to Address.

For direct deposit setup, enter your entity's information. Both saving and checking accounts are accepted; however no foreign banks are allowed. Payment notifications will be sent to the e‐mail you have provided.

You must mark yes or no for the question “Will these payments be forwarded to a financial institution outside the United States.” If left blank the ACH/Bank information will not be added.

The form must be signed or it will be considered invalid.

Privacy Notice: You are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); You are entitled to receive and review that information ; & you are entitled to have the information corrected at no charge to you.

Please mail or Fax to: Texas A&M University, FMO‐AP, TAMU MS 6000, College Station, TX 77843‐6000; 979‐458‐4191 fax;

For questions email vendorhelp@tamu.edu (Rev 09/15)