ESBD_531301_1782332847716_Exhibit G.4 - Application for Texas Identification Number (1).pdf
PDF 624 KB Posted
- Attached to
- Lubbock Fuel Point Replacement
- Solicitation number
- TMD26-FMO-0042995
- Issued by
- Harris County, Texas
About this file
This is an Application for Texas Identification Number (Form AP-152), a state agency form used by the Texas Comptroller's office to establish or verify identification numbers for entities conducting business with the state of Texas. The form is associated with the Lubbock Fuel Point Replacement contract opportunity in Texas. The application serves as a prerequisite document for entities seeking to receive payments from state agencies and requires comprehensive payee information including business name, mailing address, contact details, and tax identification numbers such as Employer Identification Numbers (EIN), Social Security Numbers (SSN), or Individual Taxpayer Identification Numbers (ITIN).
The form collects critical business structure information through ownership code classifications, including options for sole proprietorships, partnerships, corporations, professional associations, governmental entities, and other business types. Applicants must indicate whether they are new accounts or existing accounts with current Texas Identification Numbers, disclose any existing Texas tax reporting obligations such as sales tax or franchise tax, and provide authorization through authorized signature and date. The form includes optional sections for payment assignment details, security type codes, and zone codes for administrative processing. This document is essential for vendor registration and payment processing within Texas state procurement systems.
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Text version
SIC
code
| Payee | Information | (Please type or print) | ||||||||
| 4. | Name | of | payee | (Individual | or | business | to | be | paid) |
5. Mailing address where you want to receive payments
6. (Optional)
7. (Optional)
8. (Optional)
9. City State ZIP code
10.
Payee telephone number (Area code and number)
Security type code ( 0, 1, 2 )
Zone code
| 2. | Texas | Identification | Number | (TIN) | - | Indicate the type of number you are providing to be used for your TIN | |
| Employer | Identification | Number | (EIN) | (9 digits) |
(SSN)Social Security number (9 digits)
Individual Taxpayer Identification Number (ITIN) (9 digits)
| Comptroller's | assigned | number | (FOR | STATE | AGENCY | USE | ONLY) | (11 digits) | |
| Current | Texas | Identification | Number | (FOR | STATE | AGENCY | USE | ONLY) | (11 digits) |
| 3. | Are | you | currently | reporting | any | Texas | tax | to | the | Comptroller's |
| office | such | as | sales | tax | or | franchise | tax? | YES | NO |
Enter the number indicated
If "YES," enter Texas Taxpayer Number
1. Is this a new account? YES Mail Code 000 NO Enter Mail Code Agency number Complete Sections 1 - 5 Complete Sections 1, 2 & 5
For Comptroller's use only
11. Ownership Codes - Check only one code by the appropriate ownership type that applies to you or your business.
L - Texas Limited Partnership:
If checked, enter the
Texas File Number
Owner's name
T - Texas Corporation:
If checked, enter the Texas File Number
SSN / ITIN (9 digits) A - Professional Association:
If checked, enter the Texas File Number
If checked, enter the exas File Number
C - Professional Corporation:
T
Name
SSN / ITIN / EIN (9 digits)
Name
SSN / ITIN / EIN (9 digits)
I - Individual Recipient (not owning a business)
| S | - | Sole | Ownership | (Individual | owning | a | business): | If | checked, |
| enter | the | owner's | name | and | Social | Security | number | (SSN) |
P - Partnership: If checked, enter two partner's names and
| Social | Security | numbers | (SSN). | If | a | partner | is | a | corporation, | use |
| the | corporation's | Employer | Identification | Number | (EIN). |
O - Out-of-State Corporation
G - Governmental Entity
U - State agency / University
F - Financial Institution
R - Foreign (out of U.S.A.)
N - Other: If checked, explain.
12. Payment Assignment? YES NO Note: A copy of the assignment agreement between payees must be attached.
Assignee name
Assignee TIN Assignment date
13. Comments Authorized signature (Applicant or authorized agent) Date
14.
Agency name Prepared by Phone (Area code and number)
15.
AP-152
(Rev.8-21/18)
Application for Texas Identification Number
• See instructions on back
Se ct io n
Se ct io n
Se ct io n
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| IntUse2: AGENCY USE ONLY |
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| IntUse1: AGENCY USE ONLY |
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| IntUse3: AGENCY USE ONLY |
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| Item2a9: 742884783 |
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File details come from the government source that posted it. Updated .