Vendor/Payee Registration Form
Instructions For Completing the Vendor/Payee Registration Form
The Registration Form should be used to perform the following:
• Register for a new Washington Statewide Vendor Number.
• New legal name (ex: change of last name, change of company name).
• Changing your tax type (ex. changing from sole proprietor to partnership).
Note: If you are a foreign entity, please submit an IRS form W-8. You can find this form at the IRS website. You
must have a US Taxpayer Identification Number (TIN) to register with Washington State.
Part A – Contact Information:
• Mailing Address – Please indicate the address you wish to receive remittance and/or correspondence.
• Contact Name – The person named here will be contacted to approve any future changes to your registration
including direct deposit. (If you are a business, a contact person’s name MUST be provided).
• Telephone Number – The telephone number of the authorized contact person.
• Email Address – The Email address provided will be used as the primary contact method (you will be contacted
via email with your Statewide Vendor Number).
Part B – Registration (W-9):
• All numbered sections except section 4 are required.
• If you are a medical or legal/attorney entity and file with the IRS as a corporation or partnership, please
indicate your entity type in box 4.
• You MUST provide your legal address in lines 5 and 6.
• You MUST provide your Social Security Number (SSN) or Employer Identification Number (EIN). Do NOT
provide both.
Direct Deposit Banking:
To set up direct deposit, complete and submit a Direct Deposit Authorization Form.
Changes and Adding Additional Locations:
To make changes to an existing registration or to add/delete locations to an existing registration, please complete
and submit a Change Form.
Signature Block:
Please sign with a pen (a “wet signature”). Electronic, inserted or stamped signatures will not be accepted. This
form is not considered valid unless it is signed.
Submitting the Vendor/Payee Registration Form:
Please PRINT and SIGN the completed form
SCAN
to PDF format and EMAIL to:
FAX to: (360) 664-3363 OR
MAIL to: Statewide Payee Registration, PO Box 41450, Olympia, WA 98504-1450
For questions about the form, please contact the Payee Registration Unit at (360) 407-8180 ext. 5. For any other
questions, please contact the agency you are expecting payment from.
Rev. 02/2024
PLEASE DO NOT STAPLE
Vendor/Payee Registration Form
PART A – Contact Details
Mailing Address:
City:
State: Zip code:
Contact Person:
Telephone Number:
Email Address:
PART B – Vendor/Payee Registration
Request for Taxpayer Identification Number and Certification – Substitute Form W-9
1. Le gal N
ame (as shown on your income tax return):
2.Business Name, if different from Legal Name above – e.g., Doing Business As (DBA) Name:
3. Check ONLY ONE box:
SSN or EIN:
Individual/Sole Proprietor (Including LLC-Sole Proprietor)
SSN only:
Lived Experience - Class 1
Volunteer
Board/Committee member
EIN
only:
Corporation (Including S-Corp,
LLC S-Corp and LLC-Corp)
Partnership (Includes LLC)
Non-Profit Organization
Tax Exempt Organization
Local Government
State Government
Federal Government (including Tribal)
Trust/Estate
4. For Corporation or Partnership ONLY, check one box below if applicable:
Medical Attorney/Legal
5.
Legal
Address (number
street and apt
or
suite
no
)
This
should be
the
address
on file
with the
IRS:
6.
City,
State,
Zip:
7.
Tax
Identification
N
umber
(TIN)
PLEASE C
HECK
ONE
For individuals, this is your social security number (SSN)
For other entities, this is your employer identification number (EIN)
Enter your EIN or SSN (do NOT enter both):
8. Certification
I. The number shown o
n this form is my correct taxpayer identification number (or I am waiting for
a number to be issued to me), and
II. 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
III. I am a U.S. person, including a U.S. resident alien (defined
in the W-9 instructions to be found at ), and
www.irs.gov
IV. The FATCA code(s) e
ntered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certifica
tion 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. Please note this form does not include a FATCA exemption code field, and therefore item 4 does not apply.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid
backup withholding.
SIGNATURE OF U.S. PERSON (No electronic, stamped or inserted signatures)
Date: This form is valid for 90 days
Rev. 02/2024
