FIN - Vendor Verification Form

Vendor Verification Form

Valparaiso University | Office of Procurement
1700 Chapel Drive | Kretzmann Hall | Valparaiso, IN 46383
Phone: 219.464.5225 | Email: vu.purchasing@valpo.edu
Please attach a completed W-9 Certificate with the following Vendor Verification Form.

W-9 Certificate
Company Name
DBA (if applicable)
Federal Tax I.D. # ( _ _-_ _ _ _ _ _ _ )
Must be 10 characters. Currently Entered: 0 characters.
Please include the dash after the first two digits.
Check all certificates that apply:

Check all certificates that apply: Small Business Woman Owned Minority Owned
Contact Information
Principal Place of Business Principal Place of Business
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number - ### - ### ####
Fax Number Fax Number - ### - ### ####
Email
Orders

Contact information
Does your company have different contact information for where to send orders?

Does your company have different contact information for where to send orders? Yes No
Orders Orders
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number - ### - ### ####
Fax Number Fax Number - ### - ### ####
Email
Payment Remittance

Contact Information
Does your company have different contact information for remitting payments?

Does your company have different contact information for remitting payments? Yes No
Payment/Remittance Address Payment/Remittance Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number - ### - ### ####
Fax Number Fax Number - ### - ### ####
Email
ACH/Direct Deposit - Payment Information

Please complete ACH/Direct Deposit for payment of your invoice. Enroll now at: Sign up for Vendor ACH/Direct Deposit
Payment / Discount Terms

Payment / Discount Terms 2%/10/Net30 1%/15/Net30 Net30 Other Other
PLEASE NOTE: An invoice is required for payment, and ALL invoices must be sent to: vu.accounting@valpo.edu
Upload W-9

Attach Files

You may upload your W-9, ACH/payment, or other information here.
Upload any additional documents

Attach Files
Submitter Email Address
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FIN - Vendor Verification Form

Vendor Verification Form

Please attach a completed W-9 Certificate with the following Vendor Verification Form.

Contact Information

Orders

Payment Remittance

ACH/Direct Deposit - Payment Information

PLEASE NOTE: An invoice is required for payment, and ALL invoices must be sent to: vu.accounting@valpo.edu