State of Oklahoma Office of State Finance Vendor Maintenance Vendor/Payee Form Change Existing Address # Additional Address The State of Oklahoma requires the following information for all new vendors (payees) before any payments can be made. This information is used to establish you in the State’s vendor file. The form must be signed to be valid. This form should not be used to establish Garnishment Vendors or State Employee Vendors. AGENCY SECTION Agency Name Contact Name 1099 Reportable Status Phone #: Fax#: Attention Paying Agency: Please check the Add box on the left if payments to this vendor/Payee are represented by Account Codes listed on page 3 of this form. If the vendor is incorrectly showing as 1099 Reportable, check the Remove box. The PeopleSoft system requires specific details regarding the type of transaction. Please check the box that applies to this vendor: Add: 1 - Rents 2 - Royalties 3 - Prizes & Awards Remove: 6 - Medical & Health Care 7 - Non-Employee Compensation 10 – Crop Insurance Proceeds 14 – Gross Proceeds to an Attorney PeopleSoft (Oracle) 10-digit Vendor #: VENDOR/PAYEE SECTION (Please print or type this information. Complete and fax to requesting State Agency) Company Name (or Individual, or Government Entity) Phone # Fax # Name on IRS Record (if different than above) Phone # Fax # VENDOR/PAYEE TIN/SSN: Business Address: (PO Box or Street, City, State, 9-Digit Zip Required) E-mail Address Optional Address – check as appropriate: If different, Pricing Ordering Invoicing Remitting Returning Phone # (PO Box or Street, City, State, 9-Digit Zip Required) Fax # E-mail Address Contact Name & Title: If different, Pricing Ordering Invoicing Remitting Returning Phone # (PO Box or Street, City, State, 9-Digit Zip Required) Fax # E-mail Address Contact Name & Title: Customer Service Information, if different: Phone # Fax # E-mail Vendors/Payees DO NOT fax to OSF The form must be returned to the state agency requesting this information. Use OSF_GARNVEND form for Garnishment Vendors. State Agency, fax completed and signed form to: OSF, Attention Vendor Maintenance 405-521-3383. OSF/DCS USE ONLY: Date Posted: OSF/VENDOR MAINTENANCE – “VENDOR/PAYEE FORM” (11/2010) By: PAGE 1 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com SUPPLEMENTAL INFORMATION – ALL VENDORS OR PAYEES The information below is requested under U.S. Tax Laws. Failure to provide this information may prevent you from being able to do business with the State, or may result in the State having to deduct backup withholding amounts from its remittances to you. Federal Employer Identification Number (FEIN) U.S. Taxpayer Identification Number (TIN) If none, but applied for, date applied U.S. Social Security Number (SSN) If none, but applied for, date applied Check the box below that best describes your residency status: Companies: Domestic (U.S.) sole proprietorship Foreign (non-U.S.) sole proprietorship* Foreign (non-U.S.) other* - explain: Individuals: Citizen (individual) of the United States Domestic (U.S.) partnership Foreign (non-U.S.) partnership* Domestic (U.S.) corporation Foreign (non-U.S.) corporation* Resident alien (individual) of the United States Domestic (U.S.) other Non-resident alien (individual) ** * NOTE: IF YOU MARK THIS BOX, WE WILL FORWARD AN INTERNAL REVENUE SERVICE (IRS) FORM W-8 (http://www.irs.gov/pub/irspdf/fw8ben.pdf), CERTIFICATE OF FOREIGN STATUS, TO YOU. THIS MAY EXEMPT YOU FROM BACKUP WITHHOLDING. FORM W-8 DOES NOT EXEMPT YOU FROM THE 30% (OR LOWER PERCENTAGE BY TREATY) NONRESIDENT WITHHOLDING TAXES. TO CLAIM THIS EXEMPTION, YOU MUST FILE IRS FORM 8233 WITH US. FOR MORE INFORMATION, REFER TO IRS PUBLICATION 519. SIGNATURE - AND SUBSTITUTE IRS FORM W-9 CERTIFICATION Under penalties of perjury, I certify that the above information is correct and 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. 3. 3. I am a U.S. person (including a U.S. resident alien). 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 Signature of Vendor Representative or Individual Payee Date Title of individual signing form for company Vendor/Payee (Same as Company Name from Page 1) IRS Instructions Regarding 1099 MISC Reporting IRS Instructions regarding 1099 MISC reporting are posted on the IRS website at: http://www.irs.gov//instructions/i1099msc/index.html. Reportable payments include (a) royalties or broker payments in lieu of dividends or tax-exempt interest; (b) rents, services (including parts and materials), prizes and awards, other income payments, medical and health care payments, crop insurance proceeds, cash payments for fish (or other aquatic life) you purchase from anyone engaged in the trade or business of catching fish; (c) any fishing boat proceeds; or (d) gross proceeds paid to an attorney (see below). Generally, if reportable payments do not fall under Box 1, 2, 3, 6 or 14, use Box 7. Specifically, all payments to physicians and medical corporations must be reported in Box 6. Attorney's fees, including payments to a law firm or other provider of legal services, are reportable in Box 7, except for gross proceeds. Gross proceeds paid to attorneys, under IRC section 6045(f), are reportable in Box 14. These include the total amount paid to an attorney for settlement agreements. These rules apply whether or not the legal services are provided to the payer and whether or not the attorney is exclusive payee (e.g., the attorney's and claimant's names are on one check). However, these rules do not apply to wages paid to attorneys that are reportable on Form W-2. OSF/VENDOR MAINTENANCE – “VENDOR/PAYEE FORM” (11/2010) PAGE 2 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com OSF Account Codes for 1099 Reporting - By Category 1 - RENTS 2 - ROYALTIES 532110 Rent of Office Space 553170 Royalties 532120 Rent of Land 532130 Rent of Other Building Space 532140 Rent of Equipment and Machinery 532150 Rent of Telecommunications Equip 532160 Rent of Electronic Data Processing Equipment 532170 Rent of Electronic Data Processing Software 532190 Other Rents 3 - PRIZES AND AWARDS 552140 Incentive Awards – Monetary & Material 552160 Incentive Payments – Oklahoma Horse Breeders & Owners 552170 Incentive Payments – Oklahoma Film Enhancement Rebate 553220 Indemnities, Restitution, and Setttlements 6 - MEDICAL & HEALTH CARE PAYMENTS 515700 Offices of Physicians (except Mental Health Specialists) 515710 Offices of Physicians, Mental Health Specialists 515720 Offices of Dentists 515730 Offices of Chiropractors 515740 Offices of Optometrists 515750 Offices of Mental Health Practitioners (except Physicians) 515760 Offices of Physical, Occupational & Speech Therapists, & Audiologists 515770 Offices of Podiatrists 515780 Offices of all other Miscellaneous Health Practitioners 515790 Family Planning Centers 515800 Outpatient Mental Health & Substance Abuse Centers 515810 Other Outpatient Care Centers 515820 Medical and Diagnostic Laboratories 515830 Home Health Care Services 515840 Ambulance Services 515850 All other Ambulatory Health Care Services 515860 General Medical & Surgical Hospitals 515870 515880 515890 515900 515910 515920 515930 537210 551230 551240 551250 Psychiatric & Substance Abuse Hospitals Specialty Hospitals (except Psychiatric & Substance Abuse) Nursing Care Facilities Residential Mental Retardation Facilities Residential Mental Health & Substance Abuse Facilities Community Care Facilities for the Elderly Other Residential Care Facilities Laboratory Services & Supplies Medical Services to Indigent (from agencies other than DHS) Hospital Services to Indigents (from agencies other than DHS) Other Health Services to Indigents (from agencies other than DHS) 7 - NON-EMPLOYEE COMPENSATION 515010 Office of Lawyers 515020 Offices of Notaries 515030 Other Legal Services 515060 Accounting, Tax Preparation, Bookkeeping & Payroll Services 515210 Payments for Contract Mentor Services 515220 Architectural Services 515230 Landscape Architectural Services 515240 Engineering Services 515250 Drafting Services 515260 Building Inspection Services 515270 Geophysical Surveying & Mapping Services 515280 Surveying and Mapping (except geophysical) Services 515290 Testing Laboratories 515300 Interior Design Services 515310 Industrial Design Services 515320 Graphic Design Services 515330 Other Specialized Design Services 515350 Custom Computer Programming Services 515360 Computer Systems Design Services 515370 Computer Facilities Management Services 515380 Other Computer Related Services 515400 Administrative Management & General Management Consult Services 515410 Human Resources & Executive Search Consulting Services 515420 Marketing Consulting Services 515430 Process, Physical Distribution, & Logistics Consulting Services 515440 Other Management Consulting Services 515450 Environmental Consulting Services 515460 Other Scientific & Technical Consulting Services 515470 Research & Development in the Physical, Engineering, & Life Sciences 515480 Research & Development in the Social Sciences & Humanities 515490 Advertising and Related Services 515500 Marketing Research & Public Opinion Polling 515510 Photographic Services 515520 Translation & Interpretation Services 515530 Veterinary Services 515540 All other Professional, Scientific and Technical Services 515550 Management of Companies & Enterprises 515560 Office Administrative Services 515570 Employment Placement Services 515580 Business Support Services 515590 Document Preparation Services 515600 515610 515620 515630 515640 515650 515660 515940 515950 Telephone Call Centers Business Service Centers Collection Agencies Credit Bureaus Other Business Support Services Investigation & Security Services Educational Services Individual & Family Services Community Food & Housing & Emergency & Other Relief Services Vocational Rehabilitation Services Child Day Care Services Arts, Entertainment and Recreation Other Services (except Public Administration) Printing and Binding Contract Advertising Informational Services Exhibitions, Shows and Special Events Burial Charges Jury and Witness Fees Payments for Photographing Supplies and Services Maintenance and Repair of Buildings and Grounds (outside vendors) Maintenance and Repair- Equipment (outside vendors) Maintenance and Repair of Telephone Equipment (outside vendors) Maintenance and Repair of Data Processing Equipment (outside vendors) Maintenance and Repair of Data Processing Software (outside vendors) Land Improvements Buildings and Other Structures –Construction and Renovation Major Maintenance and Repair of Equipment Highway and Bridge Construction Expense-Contractual Maintenance and Repairs to Highways and Bridges Major Maintenance and Renovation –Bridges Teacher Stipends (“Incentive” payments) Legal Settlements Reportable to the IRS Voter Registration Services Stipends – Other Non-Employee 515960 515970 515980 515990 531150 531160 531170 531190 531220 531330 531390 533110 533120 533130 533140 533150 545110 546210 546220 547110 547120 547210 552120 553160 554190 552100 14 - GROSS PROCEEDS TO AN ATTORNEY 553180 Settlements – Paid To/Thru Attorney OSF/VENDOR MAINTENANCE – “VENDOR/PAYEE FORM” (11/2010) PAGE 3 OF 3 American LegalNet, Inc. www.FormsWorkFlow.com