Print Form
Finance & Administration
Controllers Division, Procurement Services
New Supplier Setup Form
RIT Contact Name:
Type of Organization:
Individual (SSN)
Contact Phone:
Sole Proprietor (Fed. ID/SSN)
Contact Email:
Supplier Instructions: Send the completed form to the
Procurement Services Office along with a completed
W-9 Form. (124 Lomb Memorial Drive, Rochester, NY
14623 or fax to 585-475-7171)
Supplier Information:
Partnership (Fed. ID)
Incorporated Bus. (Fed. ID)
Yes
Publicly Traded?
No
Non-Profit Org. (Fed. ID)
Please indicate your organization's tax status:
Legal Name:
If individual, enter last name first
Trade Name (DBA):
501(c)(3)
501(c)(8)
501(c)(4)
501(c)(6)
Not Tax Exempt
501(c)(7)
Other
Invoicing Name:
Contact Name:
Business Size and Classification:
Contact Title:
Please check either Large or Small to indicate
the business size. Then check any relevant
classifications of the business
Contact Phone:
Email:
Disadvantaged
Remit To Address:
Woman-Owned
Svc Disabled Veteran
Street:
Large
Small
Veteran-Owned
Minority Owned
HUB Zone
For Minority-Owned Businesses Only:
P.O. Box:
City:
State:
Zip:
African American
Latin American
Country:
Phone Number:
Fax Number:
Physical Address:
Native American
Disabled Veteran
Veteran
Asian
Other (Specify)
Same as Remit to
Street:
Conflict of Interest:
P.O. Box:
A conflict of interest may exist where an RIT employee or close
relative/family member has a connection to the above business,
and a third party may consider that this relationship may
compromise the competitive process. Does any RIT employee
have a possible conflict of interest with the above business?
City:
State:
Zip:
Country:
Phone Number:
Fax Number:
Yes
No
Terms:
If yes, please specify the following:
Standard Payment Terms: RIT only accepts net 30
RIT Employee Name:
Reason For Payment:
Phone Number:
Goods
Brief Description
Services
Brief Description
Honorarium
Employee's Relationship:
Expense Reimbursement
Preparer's Information:
I certify that: All responses provided herein, including vendor classifications, are true and accurate. I am not subject to backup
withholding due to failure to report interest and dividend income
Certified By:
_________________________________________________________________
PrintName/ Title:
https://www.rit.edu/fa/procurement/sites/rit.edu.fa.procurement/files/forms/vendorsetup.pdf
Date
November 2014