Form OSPV100 "Vendor Maintenance Request" - Arkansas

What Is Form OSPV100?

This is a legal form that was released by the Arkansas Department of Finance & Administration - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Arkansas Department of Finance & Administration;
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  • Fill out the form in our online filing application.

Download a fillable version of Form OSPV100 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Finance & Administration.

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Download Form OSPV100 "Vendor Maintenance Request" - Arkansas

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1
Department of Finance and Administration
Office of State Procurement
Vendor Maintenance Request - Form OSPV100
Choose One:
ACCOUNT GROUP
NEW
Standard Goods/Service Vendor
CHANGE Vendor Number:
Payroll/Garnishment/Benefit Vendor
DELETE Vendor Number:
Board
Agency
TAX INFORMATION
Tax ID:
Social Security Number:
VENDOR ADDRESS INFORMATION
PREVIOUS
NEW
Vendor’s Name:
Vendor’s Name:
Name Continued:
Name Continued:
DBA:
DBA:
Address:
Address:
Address Continued:
Address Continued:
City:
City:
State:
Zip Code:
State:
Zip Code:
1
Department of Finance and Administration
Office of State Procurement
Vendor Maintenance Request - Form OSPV100
Choose One:
ACCOUNT GROUP
NEW
Standard Goods/Service Vendor
CHANGE Vendor Number:
Payroll/Garnishment/Benefit Vendor
DELETE Vendor Number:
Board
Agency
TAX INFORMATION
Tax ID:
Social Security Number:
VENDOR ADDRESS INFORMATION
PREVIOUS
NEW
Vendor’s Name:
Vendor’s Name:
Name Continued:
Name Continued:
DBA:
DBA:
Address:
Address:
Address Continued:
Address Continued:
City:
City:
State:
Zip Code:
State:
Zip Code:
2
VENDOR CONTACT INFORMATION
Salesperson (Optional):
Telephone Number:
Fax Number:
Email Address:
DIRECT DEPOSIT INFORMATION (Enter only if required by Vendor)
Please submit a copy of the voided check.
Add
Change
Cancel
Checking
Savings
Bank Name:
Account Type:
Bank Routing #:
Bank Account #:
Account Holder:
(List Bank Acct. holder, if different from Vendor)
PAYMENT TERMS
Select Option Below
Select Option Below
Payment Terms:
1099 REPORTABLE
Select Option Below
Select Option Below
Exemption Codes:
DISABLED WORK CENTER
Check here if vendor is a licensed or certified work center.
PARTNER INFORMATION
Partner Vendor Number:
Physical Address
Remittance Address
3
AGENCY CONTACT INFORMATION
Requester’s Name:
Email Address:
Telephone #:
Fax #:
Purchasing Org. #:
Agency Name:
Agency Address:
City:
State:
Zip Code:
Check here if agency has a hard copy of W-9.
The Arkansas Economic Development Commission (AEDC), Minority and Women-Owned Business
Enterprise (MWBE) division will designate vendors as minority, women-owned, or service-disabled
veteran-owned minority business enterprises. If you have questions about this designation or need a
designation added/updated, contact the MWBE division of AEDC at
VendorMaintenance@ArkansasEDC.Com.
W-9
Request for Taxpayer
Give Form to the
Form
Identification Number and Certification
requester. Do not
(Rev. November 2017)
send to the IRS.
Department of the Treasury
Go to www.irs.gov/FormW9 for instructions and the latest information.
Internal Revenue Service
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
4 Exemptions (codes apply only to
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
certain entities, not individuals; see
following seven boxes.
instructions on page 3):
C Corporation
S Corporation
Partnership
Trust/estate
Individual/sole proprietor or
single-member LLC
Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
(Applies to accounts maintained outside the U.S.)
Other (see instructions)
5 Address (number, street, and apt. or suite no.) See instructions.
Requester’s name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
or
Employer identification number
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Part II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above 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 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. See the instructions for Part II, later.
Sign
Signature of
Here
U.S. person
Date
General Instructions
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise
• Form 1099-MISC (various types of income, prizes, awards, or gross
noted.
proceeds)
Future developments. For the latest information about developments
• Form 1099-B (stock or mutual fund sales and certain other
related to Form W-9 and its instructions, such as legislation enacted
transactions by brokers)
after they were published, go to www.irs.gov/FormW9.
• Form 1099-S (proceeds from real estate transactions)
Purpose of Form
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
An individual or entity (Form W-9 requester) who is required to file an
1098-T (tuition)
information return with the IRS must obtain your correct taxpayer
• Form 1099-C (canceled debt)
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
• Form 1099-A (acquisition or abandonment of secured property)
taxpayer identification number (ATIN), or employer identification number
Use Form W-9 only if you are a U.S. person (including a resident
(EIN), to report on an information return the amount paid to you, or other
alien), to provide your correct TIN.
amount reportable on an information return. Examples of information
If you do not return Form W-9 to the requester with a TIN, you might
returns include, but are not limited to, the following.
be subject to backup withholding. See What is backup withholding,
• Form 1099-INT (interest earned or paid)
later.
W-9
Form
(Rev. 11-2017)
Cat. No. 10231X
Print Form
Email Form
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