City University Of New York Vendor Form

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Rev: 140204
Vendor Records Management Unit - Vendor (Payee) Registration Form
HC
PS
NR
For CUNY Use Only:
*
Part I: Which CUNY college requested you to complete this Vendor (Payee) Registration Form?
College Name: ______________________________________________________________________________________________
Name of College Contact Person: _______________________________________________________________________________
Contact’s Email Address: _________________________________________________
Phone Number: ______________________
*
Part II: Vendor (Payee) Information
1. Legal Business Name:
2. If you use a DBA (Doing-Business-As) name, please list below: (Optional)
3. Entity Type (Check
ONE
only):
Corporation
Government Agency including Hospital
Non-Profit including Hospital
Foreign Individual/Entity
Individual/Sole Proprietor
Partnership
LLC
Profit Education
Other _____________________________________________
4. What are you supplying to CUNY? (Check
ALL
appropriate box(es))
Merchandise
Telegram/Telephone/Freight/Storage Services
Health Care Service
Attorney
Other Services ________________________________________________________________________
*
Part III: Taxpayer Identification Number (TIN) Information
1. Enter your TIN here: (If your TIN is a SSN, DO NOT email form but mail or fax to CUNY Vendor Records Management Unit)
2. Taxpayer Identification Type ( Check ONE only):
Employer ID No. (EIN)
Social Security No. (SSN)
Individual Taxpayer ID No. (ITIN)
N/A (Foreign Individual/Entity)
*
Part IV: Main Business Address
Number, Street, Apartment or Suite Number
City, State, Zip Code, Country
Page 1

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