My Meredith - Submit form - SUBSTITUTE W-9 FORM Request for Taxpayer Identification Number

Vendor Name*

Phone Number*

Email*

Physical Address

Address Line 1*

Address Line 2

City*

State*

Zip*

Remit address is the same as physical address*

Yes

No

Tax and Payment Information

Tax ID*

Organization Type/Tax Classification*

Payment Terms*

Upon Reciept

30 Days

60 Days

Other

Referral Information

Please include the name and email address of the person your vendor has been in contact with at Meredith College.

Name*

Referral email*

Verification

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 from 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 longer subject to backup withholding

*Valid PO number must appear on all invoices.

*Vendor must charge all applicable sales tax.

I understand the terms and certify my compliance*

Name*

Title*

Date Certified*

Signature*

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