Supplier Management Forms

Miscellaneous Payee Registration Form

Note: To be completed by an Individual payee for payments such as honorariums and travel reimbursement or Brown University students for prize payments. We require the same name/SSN combination as it appears on your income tax return.

Section 1: Payee's General Information

first name of Individual Payeelast name of Individual Payeeemail of Individual PayeeTelephone Number of Individual Payee

Individual Payee's Permanent AddressAddress Line 1Number & Street or PO Box.Address Line 2CityState

Zip or Postal Code(indicate N/A if none)country

Use Same address for Individual Payee's Mailing Address

Individual Payee's Mailing AddressAddress Line 1Number & Street or PO Box.Address Line 2CityState

Zip or Postal Code(indicate N/A if none)country

Please provide one of the following U.S. tax numbers

Social Security Number

Individual Tax ID Number (ITIN)

I don't have a U.S. tax reporting number

Federal Employer's Identification Number

Please select one of the following:

US Citizen

Permanent Resident

foreign national

Brown Department InformationName of Brown University Department contact.Reason for Payment to Individual

Section 2: Bank Account Information

EFT (Direct Deposit) payments are available for U.S. Banks Only.

This form authorizes Brown University to make payments to an individual electronically and to deposit funds into the account specified below. It also authorizes Brown University and the bank to initiate the transaction(s) necessary to correct an error. This electronic payment authorization will remain in effect until the University has received written notification from the payee to terminate and the University has had reasonable opportunity to act upon it.

Notification of payments will be sent by email, with the payment settling into your bank account within two days. It is the responsibility of the individual to notify Brown of any changes pertinent to electronic payments, such as changes in banking information or email address.

Select account type

checking

savings

Name of BankName on Bank AccountBank Routing Number (9 digits)Account Number

How to Find the Routing Number on Your Check

check identifying associated number code types

Printed along the bottom of the check are three groups of numbers; the first nine digits are the banks routing number, the second set is your account number and the last set is the check number, which also appears in the upper right corner.

Funds Transfer: To comply with the requirements of the U.S. Department of Treasury and Office of Foreign Assets Control (OFAC), Brown is obligated to ask the question shown below regarding the transferring funds. If your answer is “Yes”, Brown will issue a paper check in lieu of processing a direct deposit.

Are funds transferred to the designated direct deposit account and then transferred to a bank in a foreign country?

yes