Supplier Registration Form - Brown University

Brown University Supplier and Individual Payee Registration Form

Note: To be completed ONLY by an authorized representative of the payee organization or individual to be paid. We require either the individual's name/SSN or the company's name/FEIN, as they appear on your income tax return.

Help support our sustainability efforts by registering to receive your purchase order by email.

Request

Request Type

New Registration Request

Update Existing Information

Section 1: Payee's General Information

first name of Individual Payee or Business Contactlast name of Individual Payee or Business Contactemail of Individual Payee or Business ContactTelephone Number of Individual Payee or Business ContactBusiness Name(if no business name, indicate 'n/a')

Permanent Address (Legal Address)Address Line 1Number & Street or PO Box.Address Line 2CityState

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

Use Same address for Send Payment Here

Send Payment HereAddress Line 1Number & Street or PO Box.Address Line 2CityState

Zip or Postal Codecountry

URL of websitefax numberemail for purchase order (if no business name, indicate 'n/a')Be green for Brown – provide an email address for purchase order distribution.

Section 2: Payee's Business Information

Primary Business Type for Supplier / Reason for Payment to IndividualFor Example: Consultant, Performing Artist, Fellowship, Student Prize Award Recipient, Honorarium or Reimbursement.Brown Department / ContactName of Department at Brown University that is the primary recipient of your goods or services, and Brown contact name.

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

Federal Employer's Identification Number (FEIN)

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

Is this business US Small Business Association Certified?

Yes

Check all that apply to this business (Defined as 51% or more)

Businesses that meet these qualifications are required to upload supporting documentation

women owned

minority owned

veteran owned

disabled

disadvantaged

Payment Terms

EFT is Net 5: Electronic Funds Transfer direct to your bank account (Payment within 5 business days of receipt of invoice in Brown Accounts Payable)

Net 30: Paper Check (paid within 30 business days of receipt of invoice in Brown Accounts Payable)

2% is Net 15: Paper Check (2% discount to Brown, paid within 15 business days)

Certification - select one:

W9 Certification: Under penalties of perjury, I certify that: (1) The number shown above is my correct taxpayer identification number; (2) I am not subject to backup withholding due to a failure to report interest and dividend income, (3) I am a U.S. person (including a U.S. resident alien), (4) I am exempt from FATCA (Foreign Account Tax Compliance Act) reporting.

I am a foreign national and not required to complete form W-9.

Upload w9 documentation (optional)

Bank Account Information (optional)

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

Form Questions?

Email suppliermanagement@brown.edu

The Internal Revenue Services does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.