Attachment_A_Domestic_Vendor_File_Request_Form.pdf

PC 708 (formerly PC-CFO-FS 709) (10/2010)

Domestic Vendor File Request Form

Today’s Date:

PRIVACY ACT STATEMENT: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31CFR 208 and 210. This information is used by Peace Corps and the U.S. Treasury Department to transmit payment data, by electronic means to a vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Electronic Funds Transfer (EFT) Program.

INSTRUCTIONS ON SECOND PAGE -- DIRECT FORMS AND QUESTIONS TO:

vendordatadomestic@peacecorps.gov

REQUESTER INFORMATION

Last Name: First: MI: E-mail:

Office Name:

Phone No.: ( )

VENDOR INFORMATION

Reason for Request (Please check one box): New Update REQUIRED: Indicate Reason for Update: Choose an item. If ‘Other’, specify:

Vendor Type: Select... Federal Agency ALC:

Vendor Name: First: MI:

Job Title/Position:

Birthdate: / / Tax ID # or Vendor DUNS: (Only US commercial vendors) :

Gender: M F Phone No.: ( ) E-mail Address:

Address:

City: State: Zip Code: - Country:

FINANCIAL INSTITUTION INFORMATION

Payment by: EFT Check Justification required for check payment:_____________________________________________________________

If check, is the “Remit to Address” different? If different, provide the “Remit to Address” in the lines below.

Bank Corporate Name:

Branch Name:

Address:

City State:

Zip Code: - Country:

ABA# Routing Transit Number:

Bank Account Number:

Type of Account: Checking Savings Lockbox

OTHER VENDOR INFORMATION (FOR INTERNAL PEACE CORPS USE ONLY)

1099 (PSCs, Partnerships and Corporations) Non-1099 (Employees, Overseas staff, and Orgs)

Completed By: Date: / / Vendor No:

PC 708 (formerly PC-CFO-FS 709) (10/2010)

Instructions to Completing Form 709 A Domestic Vendor File Request Form must be completed for each vendor that will conduct procurement business with a Peace Corps representative. Vendor IDs are required to establish obligations and process payments in Odyssey and to allow the agency to comply with federal reporting requirements. To insure prompt data entry by vendor maintenance staff, all relevant fields must be completed.

Requestor Information

The staff person preparing the form enters their last name, first name, middle initial, e-mail, office name, and phone number.

Vendor Information

1. Check New or Updated vendor request.

2. Indicate reason for an Updated Request from the dropdown menu.

3. Select the Vendor Type from the dropdown menu. Write out the type of Vendor if ‘Other’ is chosen.

4. If vendor is a US Federal Agency, provide its Agency Location Code (ALC).

5. If vendor is a commercial entity, enter the vendor name.

6. If vendor is a person, enter the vendor’s last name, first name, middle initial, job title/position, birth date and gender.

7. For US commercial vendors, provide Tax Identification number or Vendor DUNS*.

*If the vendor does not have a DUNS number one can be obtained at the D&B web site. All US vendors conducting business with a Federal Agency are required to have a DUNS number.

8. Indicate the vendor’s phone number, e-mail, street address, city, state, zip code, and country.

Financial Institution Information

1. Select the payment type EFT or Check and the justification for a check payment.

2. Enter the Bank name, branch name, address, city, state, zip code, and country.

3. Provide the bank’s Routing Code (ABA, Swift or other necessary routing information).

4. Provide the vendor’s bank account number.

5. Select the type of bank account.

http://www.dnb.com/us/�