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Brown University Supplier and Individual Payee Registration Form

NOTE: To be completed ONLY by an authorized representative of the payee organization or individual to be paid.

We require either the individual's name/SSN or the company's name/FEIN, as they appear on your income tax return.

Help support our sustainability efforts by registering to receive your purchase order by email.

required
New Registration Request Update Existing Information

Section 1: Payee's General Information First Namerequired

First name of Individual Payee or Business Contact.

Last Namerequired

Last name of Individual Payee or Business Contact.

Emailrequired

Email address of Individual Payee or Business Contact.

Phone Numberrequired

Telephone number of the Individual Payee or Business Contact.

Business Name (if no business name, indicate N/A)required

If no business name, indicate N/A.

Permanent Address (Legal Address)

Address Line 1required

Number & Street or PO Box.

Address Line 2

Cityrequired

State (select N/A if non-US address)required
Zip or Postal Code (indicate N/A if none)required

Countryrequired

Send Payment Here

Address Line 1

Number & Street or PO Box.

Address Line 2

City

State Zip or Postal Code (indicate N/A if none)

Country

URL for Website

Fax Number

Email for Purchase Order (indicate N/A if not applicable)required

Be green for Brown – provide an email address for purchase order distribution.

Section 2: Payee's Business Information Primary Business Type for Supplier / Reason for Payment to Individualrequired

For Example: Consultant, Performing Artist, Fellowship, Student Prize Award Recipient, Honorarium or Reimbursement.

Brown Department / Contactrequired

Name of Department at Brown University that is the primary recipient of your goods or services, and Brown contact name.

Please provide one of the following U.S. tax numbersrequired
Federal Employer's Identification Number (FEIN)
Social Security Number
Individual Tax ID Number (ITIN)
I don't have a U.S. tax reporting number

Federal Employer's Identification Number (FEIN)

Corporations/Partnerships must provide an FEIN

Social Security Number

Individuals and Sole Proprietors without FEIN must provide a Social Security Number

Individual Tax ID Number

If you have an Individual Tax ID number, you must provide it.

Are you a Foreign National/Resident of another country?required
Yes
No

If yes, what country issued your passport?required

If you are a US Permanent Resident card holder please select No.

required I am a:
Sole Proprietor or Individual
C Corporation
S Corporation
Partnership
Trust Estate
Other (please specify)

Is this business US Small Business Association Certified?required
Yes
No

Check all that apply to this business (Defined as 51% or more)

Women Owned

Minority Owned

Veteran Owned

Disabled

Disadvantaged

Businesses that meet these qualifications are required to upload supporting documentation

Payment Terms EFT is Net 5: Electronic Funds Transfer direct to your bank account (Payment within 5 business days of receipt of invoice in Brown Accounts Payable)
Net 30: Paper Check (paid within 30 business days of receipt of invoice in Brown Accounts Payable)
2% is Net 15: Paper Check (2% discount to Brown, paid within 15 business days)

requiredCertification - select one:
W9 Certification: Under penalties of perjury, I certify that: (1) The number shown above is my correct taxpayer identification number; (2) I am not subject to backup withholding due to a failure to report interest and dividend income, (3) I am a U.S. person (including a U.S. resident alien), (4) I am exempt from FATCA (Foreign Account Tax Compliance Act) reporting. I am a foreign national and not required to complete form W-9.

Bank Account Information (optional)

EFT (Direct Deposit) payments are available for U.S. Banks Only.

This form authorizes Brown University to make payments to a business or individual electronically and to deposit funds into the account specified below. It also authorizes Brown University and the bank to initiate the transaction(s) necessary to correct an error. This electronic payment authorization will remain in effect until the University has received written notification from the payee to terminate and the University has had reasonable opportunity to act upon it.

Notification of payments will be sent by email, with the payment settling into your bank account within two days. It is the responsibility of the business or individual to notify Brown of any changes pertinent to electronic payments, such as changes in banking information or email address.

Select account type: Checking
Savings
Name of Bank

Name on Bank Account

Bank Routing Number (9 digits)

Account Number

How to Find the Routing Number on Your Check

Funds Transfer: To comply with the requirements of the U.S. Department of Treasury and Office of Foreign Assets Control (OFAC), Brown is obligated to ask the question shown below regarding the transferring funds. If your answer is “Yes”, Brown will issue a paper check in lieu of processing a direct deposit.

Are funds transferred to the designated direct deposit account and then transferred to a bank in a foreign country? Yes No

Form Questions? Email suppliermanagement@brown.edu.

The Internal Revenue Services does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

denotes required fields.Required