Form W-8ben - Certificate Of Foreign Status Of Beneficial Owner For Us Tax Withholding - 2006 Page 2
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1
2Vendor Information
Please provide as much information as possible to help facilitate a more productive working relationship with Indiana University.
Purchase Order Delivery Methods
Vendor Name
E-mail Address
Street Address or P.O. Box
City, State, Zip
Facsimile Number
If there are multiple fax numbers to which purchase orders should be sent (i.e. for different departments/product
( _____ ) - ___________________
categories), please attach a list of numbers and corresponding departments on a separate page.
Remit-to Address
Check here if same as above
Street Address or P.O. Box
City, State, Zip
Contact Information
Sales Contact
Accounts Receivable Contact
Telephone Number (with extension if applicable)
Telephone Number (with extension if applicable)
( _____ ) - ___________________ x ______
( _____ ) - ___________________ x ______
E-mail Address
E-mail Address
URL / E-mail Information
Primary URL (i.e. )
E-Mail Address for General Inquiries (i.e. info@indiana.edu)
Payment Information
Minimum Order Requirements
DUNS Number - provided by Dun & Bradstreet
Do you accept Visa?
Yes
No
(if applicable)
Shipping Terms 1 – who retains ownership during
Payment Terms:
Shipping Terms 2 – who is responsible for shipping fees?
shipment?
Please note: Indiana University’s preference for
IU – Prepaid and Added to invoice
FOB Origin (IU)
payment terms is net 30 because this is the
IU – Separate bill
FOB Destination (vendor)
shortest period in which we can consistently
Vendor – “Allowed”
ensure payment. The University makes every
FOB Shipping Point (Distributor)
Paid by third party
effort to uphold to our commitment to pay our
Customs – US Port
vendors in a timely manner. If you have
Customs – International Port
questions or concerns contact the Purchasing
Department at 812-856-3057.
®
®
Please provide at least one United Nations Standard Products and Services Code
(UNSPSC
) commodity code that best describes the goods or services you
®
supply. The list of valid UNSPSC
codes is available here: https://
___________________________________________________________________________
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th
400 E. 7
Street, Bloomington, IN 47405, Phone: (812) 856-3057, Fax: (812) 855-7839, Web:
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