KENTUCKY STATE UNIVERSITY PURCHASING DEPARTMENT 400 EAST MAIN STREET FRANKFORT, KY 40601 502-597-6994 PURCHASING@KYSU.EDU
NEW REGISTRATION MODIFICATION
VENDOR REGISTRATION FORM
LEGAL NAME ON W-9 (CO. OR INDIVIDUAL)___
BUSINESS NAME(DBA)___
ADDRESSCITY
STATE___ZIP___
REMIT ADDRESS
EMAIL ADDRESS FOR ELECTRONIC PURCHASE ORDERS ___
PHONEFAX
ALTERNATE
VINORITY OWNED BUSINESS VETERAN OWNED BUSINESS
□
□ WOMEN OWNED BUSINESS □
WOMEN OWNED BUSINESS
1099 CLASSIFICATION (SELECT ONE): TAXPAYOR ID TIN TYPE
SSN □ FEIN □
INDIVIDUAL
LLC FILING AS CORPORATION
LLC FILING AS CORPORATION
STATE GOV
□
SOLE PROPRIETOR ___ LLC FILING AS PARTNERSHIP
LLC FILING AS PARTNERSHIP
OTHER GOV
□
PARTNERSHIP
LLC FILING AS SOLE PROPRIETOR
LLC FILING AS SOLE PROPRIETOR
NON RESIDENT ALIEN □
☐ TRUST
CORPORATION
TRUST
FOREIGN BUSINESS ENTITY
NAME OF BANK:___
CITY_____STATE_____ SAVINGS ○ CHECKING ○
ROUTING NUMBER(9 DIGITS):___ ACCOUNT NUMBER:___
CONTACT PHONE EMAIL ADDRESS FOR NOTIFICATIONS
KENTUCKY STATE UNIVERSITY OPERATES ON A NO PO, NO PAY POLICY. ALL ORDERS MUST GO THROUGH THE PROCUREMENT PROCESS AND ASSIGNED A VALID PO NUMBER. THE PO IS THE CONTRACT WITH THE UNIVERSITY THAT IT IS AN APPROVED PURCHASE. PLEASE NOTE THAT KENTUCKY STATE UNIVERSITY OPERATES ON A NET 30 PAY CYCLE. SIGNITURE INDICATES THAT YOU UNDERSTAND THE ABOVE.
SIGNATURE DATE