UNIVERSITY OF PITTSBURGH
PURCHASING SERVICES
SUPPLIER VERIFICATION FORM
1. Use this Supplier Verification Form to provide Purchasing Services and Payment Processing with required information to establish a new supplier or change an existing supplier in Prism. Suppliers are individuals, corporations or other entities that provide goods or services to the University.
2. University policy requires the use of contracted suppliers.
3. For low-value, one-time purchases that are not available from a University contracted supplier please use a University Pcard.
4. University employees may not be added as suppliers.
Process:
Add a new supplier or re-activate a supplier in Prism:
a) The supplier should complete Section II of the form and return it along with the appropriate Internal Revenue Service (“IRS”) forms to the University department with whom the supplier is working.
b) The University department should complete Section III of this Supplier Verification Form and then submit the completed form with the appropriate IRS attachments to Purchasing Services.
c) University departments may fax this completed Supplier Verification Form and appropriate IRS attachments to Purchasing Services at (412) 624-9339.
Changes to a supplier in Prism
a) To change only a supplier’s fax number, please use the online form.
b) To add an additional site to an already existing supplier, all sections of this Supplier Verification Form must be filled out and an appropriate IRS form submitted.
c) For changes in a supplier’s name, address, or tax identification number, an appropriate IRS form must be submitted along with a letter from the supplier on company letterhead stating the change(s).
5. IMPORTANT: The IRS requires that information be collected from all suppliers for possible tax withholding or tax reporting purposes. Collection of this information is required for new suppliers and for changes in supplier name, address, or tax identification number (such as in a merger or acquisition).
If the supplier is a U.S. company or individual, a IRS Form W-9 should be completed.
If the supplier is a foreign national individual providing independent personal services, see special instructions on the Payment Processing website. Personal services are “independent” if the University is making payment to the foreign national in his capacity as a self-employed individual.
If the supplier is a foreign organization, it should complete the appropriate IRS form in the W-8 series.
Most other foreign organizations should file a Form W-8BEN. If the foreign organization (including foreign tax-exempt organizations) is claiming the benefits of a tax treaty, it is required to file a Form W-8BEN. In order to complete the form, the supplier will need a U.S. tax identification number.
If you have any questions regarding this Supplier Verification Form please contact Purchasing Services at (412) 624-6648.
If you have any questions regarding IRS forms please contact Payment Processing at (412) 624-4004.
PLEASE PRINT CLEARLY OR TYPE
Date:
Check one: This is a new supplier (complete all applicable fields)
This is a change to an existing supplier (complete only bolded fields and those to be changed)
SUPPLIER NAME:
PURCHASE ORDER ADDRESS:
CITY/STATE/ZIP:
PRODUCTS/SERVICES PROVIDED:
PAYMENT TERMS:
SALES CONTACT NAME: PHONE NUMBER:
FAX NUMBER: EMAIL:
(Purchase Orders will be faxed to this number)
WORLDWIDE WEBSITE:
REMIT TO NAME:
REMIT TO ADDRESS:
CITY/STATE/ZIP:
ACCOUNTING CONTACT NAME: PHONE NUMBER:
FAX NUMBER: EMAIL:
DISADVANTAGED BUSINESS STATUS (IF APPLICABLE)
Check all that apply:
Large Business Small Business Woman-Owned Veteran-Owned
HUBZone
NAICS or SIC codes for products/services provided:
(definitions at http://sba.gov/size/indexsize.html )
Minority-owned Business Enterprise (Check one if applicable)
African American Native American Indian Aleuts, Alaskan American
Asian Indian American Asian Pacific American Hispanic American
Other (Please Specify)______
DBE CERTIFICATION SOURCE:
SUPPLIER NAME:
DATE:
REQUESTING DEPARTMENT INFORMATION:
This purchase cannot be made from one of the University’s current contracted suppliers (see http://www.bc.pitt.edu/purchasing/ContractedSuppliersApril05.html ) because .
REQUESTOR NAME: (PLEASE PRINT)
PHONE NUMBER: FAX NUMBER:
EMAIL ADDRESS:
DEPARTMENT NAME:
To the best of my knowledge, purchases from this supplier comply with the University Policy 05-02-02 Conflict of Interest and Procurement Relationships and with University Policy 05-02-15 Required Use of Contracted Suppliers.
UNIVERSITY BUSINESS ADMINISTRATOR NAME: (PLEASE PRINT)
UNIVERSITY BUSINESS ADMINISTRATOR SIGNATURE: ______
Y / N / N/A
CF
W9
EI
CI
CV
AC
Approved Disapproved
Reason for Disapproval:
Initials: ______Date:
Revised 5/08