Note: This form must accompany a W-9 or W-8 form to proceed with vendor setup and disbursements.

VENDOR/PAYEE NAME

PRIMARY ADDRESS

REMIT TO ADDRESS

CONTACT INFORMATION

BUSINESS CLASSIFICATION

(As per Federal SBA guidelines - SBA.gov)

VENDOR MISC. REPORTING REQUIREMENTS

SERVICE TYPE

ACH PAYMENT INFORMATION

A voided check copy must be included for direct deposit via ACH. Payment terms: Unless otherwise noted, standard payment terms are Net 30.