SUPPLIER INFORMATION REQUEST (SIR)Supplier No.______
This form is required of all Suppliers to Aerojet Rocketdyne Holdings, Inc. (AR Holdings), Aerojet Rocketdyne Inc. (AR), Aerojet Ordnance Tennessee, Inc. (AOT), and/or Easton Development Co., LLC (Easton) (collectively referred to herein as “Company”). Any individual or entity paid by Company is considered a Supplier. Information provided on this form is subject to verification, including but not limited to, IRS Tax Identification Number (TIN) Matching.
INSTRUCTIONS: (DOUBLE CLICK TO ENTER “X” IN BOXES)- For anew request, please mark Section 1 as “Initial/New Request” and complete all sections identified with yellow section heading labels; do not complete sections identified for internal use.
- To update/modify existing supplier information, please mark Section 1 as “Changes Only” and complete only section(s) with changed information – Supplier represents that all other information not specifically changed remains the same.
- Supplier Name/Address:Enteraddress where Company will send Purchase Orders/Agreements (“PO”). If you have multiple locations with a single common remittance account, use the address where we send correspondence.
- Type of Business: Indicate the legal status of your business (under Section 4 – Taxpayer Information).
- Taxpayer Information section must be completed for payments to be issued, including Employer/Taxpayer Identification Number (or Social Security Number), or Supplier may substitute IRS Form W-9 for Section 4. IRS FORM W-9 MUST BE ATTACHED.
- Contact Information: Please provide Business/Sales contact and bank remittance advice contact for electronic payments.
Complete and return form to Supply Chain: Bldg. 20001/Dept. 3048, PO Box 13222, Sacramento, CA 95813-5000
OR Fax to 916-355-3292OR email to
SECTION 1. SUPPLIER PROFILE
Initial/New Request Changes Only
Supplier Legal Name: / Parent Co. Legal Name (if any):Secondary/Trade Name/DBA: / Secondary/Trade Name/DBA:
DUNS No.: / Parent Co. DUNS No.:
CAGE/NCAGE No.: / Parent Co. CAGE/NCAGE No.:
Street Address (Line 1) / Remit/Payment Address (Line 1) - if different from Address at left
Street Address (Line 2) / Payment Address (Line 2) - if different from Address at left
City State Code (or Foreign Province, if any): / , / City State Code (or Foreign Province, if any): / ,
County9 Digit ZIP Code: / , / County9 Digit ZIP Code: / ,
Country Code (3 letter ISO code): / Country Code (3 letter ISO code):
Congressional District: / Congressional District:
Email Address (for official correspondence): / North American Industry Classification System (NAICS) – list only those sold to Company; see
Website URL:
Contact Name: / Contact Email:
Contact Phone (with area code): / FAX:
☐ Company IS incorporated or organized to do business in the United States. / ☐Company IS NOT incorporated or organized to do business in the United States.
SECTION 2. BUSINESS SIZE/SOCIOECONOMIC INFORMATION – MUST SELECT ONE OR MORE
Definitions of business sizes are found at: . Navigate to SupplierNet/Business with Aerojet Rocketdyne/Supplier Diversity
☐Foreign-owned business / ☐Government Agency
☐LARGE BUSINESS / ☐Women-Owned Small Business
☐SMALL BUSINESS. If this response is selected, please identify any additional designation(s) from the choices in this section: / ☐HUBZone: Must be CERTIFIED by the SBA ( and listed in System for Award Management (SAM) at Provide copy of certificate.
☐Self-Certified Small Disadvantaged Business. Register at / ☐Historically Black College or University/Minority Institution
☐Service Disabled Veteran-Owned Business / ☐Alaskan Native Corporation (ANC)/Indian Tribe. If 8(a) ANC, check SDB box too.
☐Veteran-Owned Small Business / ☐Non-Profit per IRS Code Sect. 501C
SECTION 3. FINANCIAL PROFILE
Payment Method: / Choose an item. / Select Currency (USD): / Choose an item. / Accept Payment by Credit Card? / Yes No
Bank Name: / Address
City / State / ZIP+4
Title on Bank Acct. / Supplier Remittance Advice Email Address
Bank Routing/ABA No. (9 Digits) EFT Info. / Bank Acct No. / Type of Acct / Payment Terms
Checking Savings
SECTION 4. TAXPAYER INFORMATION
Company is required to file form 1099 annually with the IRS disclosing reportable payments issued to select suppliers. The information supplied in this section will enable us to determine whether we are required to report any payments issued to you during the reporting year. Non-resident Alien:Complete and attach IRS Form W-8. Foreign Entities: Complete and attach IRS Form W-8BEN-E. Non-resident Alien and Foreign Entities do not need to complete this section.
Taxpayer Identification Number (TIN):
Corporation / Partnership / S Corporation / Sole Proprietor – Enter SSN:
Limited Liability Corp. (LLC) / Other (Tax Exempt Organization or Government Entity):
Tax Reporting Address (Optional) -If applicable, IRS Form 1099 is sent to the Payment Address in Section 1. If an alternate tax reporting address is preferred, enter it below.
Address:
City: / State: / Zip + 4*Req’d.
1099 CODE / 1099 RECIPIENT (Check One - not required for corporations) Call Accounting for 1099 Information
01 / Rents (Exclude Corporations)
03 / Retiree
06 / Medical & Health (Include Corporations)
07 / Non-Employee Compensation (Exclude Corporations)
07 / Other Services (Legal, Consultants, Accounting, Maintenance, Engineering, Etc.)
Please attach a fully executable Internal Revenue Service (IRS) Form W-9
SECTION 5. SUPPLIER SIGNATURE AND CERTIFICATION
CERTIFICATION INSTRUCTIONS. Cross out item 2 below if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 below does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN.
Under penalties of perjury, I certify that:
1. The Taxpayer Identification Number shown on this form is my correct number (or I am waiting for a number to be issued to me).
2.ANDI am not subject to backup withholding because:
a. I am exempt from backup withholding.
b.ORI have NOT been notified by the IRS that I am subject to backup withholding as a result of failure to report interest or dividends.
c. ORthe IRS has notified me that I am no longer subject to backup withholding.
3. AND I am a U.S. citizen or other U.S. person or if not, I am authorized to provide information required on this form.
Supplier agrees to promptly notify Company if any information changes that is subject to certification.
Authorized Supplier Representative Signature: / Title:
Authorized Supplier Representative Printed Name: / Date: / Phone:
Supplier Comments:
FOR INTERNAL USE ONLY — TO BE COMPLETED BY COMPANY REQUESTER
Purpose of SIR (Maestro): / Check all that apply:Purchasing and/or Pay or RFQ ONLY
- Active iSupplier User? / Yes. If yes, iSupplier User ID: / No If No, Activate? No Yes
- iSupplier PortalActivation: / iSupplier Portal Full Access Sourcing Supplier Supply Chain Collaboration Planner
Requested By (Internal Company Employee Name): / Email: / Phone:
Direct Product or Service: / Choose an item. /
Indirect Product or Service: / Choose an item. /
Site(s) Supplier Supports– Select all that apply: / AR Holdings AR
Easton LLC AOT / Potential Conflict of Interest? / No YesNot Sure If Yes or Not Sure, Explain Below**
**Per Company Policy, if internal Company personnel responded Potential Conflict of Interest Yes or Not Sure, explain:
FOR INTERNAL USE ONLY — TO BE COMPLETED BY COMPANY APPROVER
SCMM Manager/Category Manager Approval: / APPROVED OR NOT APPROVED (Provide reason below)
Signature: / Printed Name: / Review Date:
Internal Review Comments:
FOR INTERNAL USE ONLY — TO BE COMPLETED BY SUPPLIER ADMINISTRATOR
ABC Date(If any Gov’t POs): / ABC Expiration Date: / DDTC Expiration Date:
Entered By: / Date:
Comments:
Supplier Administrator: Enter assigned supplier number in field at top of form.
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