STATE OF DELAWARE SUBSTITUTE FORM W-9

The State of Delaware requires the following information for all vendors (payees) before any payments can be made. This information is used to populate and maintain the State's vendor file. *Required. Complete all required fields if new request or making a change.

* Form Type:

New VendorChange Profile

*Taxpayer ID:
SSNEIN	(no hyphens)
	If a Foreign company, use IRS Form W-8 available at IRS.gov

Payment Method:	The State reserves the right to provide payment by any of the following methods: credit card, ACH or by check, at the State's option.
* May we contact you about receiving credit card payments?	YesNo
* Would you like to receive payment by direct deposit?	YesNo

* Account Type CheckingSavings     * Bank Name:    * Bank Routing Number: help  * Bank Account Number: help Please allow 7 business days for bank account validation. If valid bank account information is not provided, a paper check will be issued.

Applicant Information:
*Vendor Name(Name on IRS record)
Doing Business As(if different than IRS name)

Applicant Remittance Address & Contact Information:
* Address Line 1:
Address Line 2:
* City:	* State: AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY * Zip:
* Contact Name:	* Phone #: Extn Fax #:
* Contact E-mail address:

Applicant Ordering Address & Contact Information: Check if same as Remittance Address & Contact Information
* Address Line 1:
Address Line 2:
* City:	* State: AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY * Zip:
* Contact Name:	* Phone#: Extn Fax #:
* Contact E-mail address:

Additional Reporting Elements:
Please check all that apply:	Veteran Owned Women Owned Minority Owned Emerging Small Business

* 1099 Withholding Type:

1099 Miscellaneous 1099G 1099I Not subject to 1099 reporting because        a) business is incorporated and not providing legal or medical services        b) receiving a reimbursement from the state that is not 1099 reportable            (energy grant, stipends, childcare)        c) organization is a non-profit organization.

* 1099 Withholding Class:

Certification 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: I am exempt from backup withholding, 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 The IRS has notified me that I am no longer subject to backup withholding, AND 3. I am a U.S. citizen or other U.S. person (defined below). Definition of a U.S. Person. For federal tax purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than a foreign estate), or A domestic trust (as defined in regulations section 301.7701-7)

Electronic System Submission: Under penalties of perjury I certify that:
* I am the same person (or payee's agent) accessing the system and submitting this form as identified on the Substitute Form W-9.	Agree
* By submitting this form electronically, I am affixing my electronic signature as the payee identified on the Substitute Form W-9 and I am in agreement with the State of Delaware to accept and process this transaction in electronic form	Agree
"The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding."