Vendor Application Intel System Barebone SC5650HCBRPRNA Fa Pds Ufva
User Manual: Intel System Barebone SC5650HCBRPRNA
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Vendor Application - University of Florida You may fill these forms out on-line, print them, and send them by mail, fax or email to Vendor Maintenance: Mail: University of Florida, Attn: Vendor Maintenance, PO Box 115350, Gainesville, FL, 32611-5350 Fax: Attn: Vendor Maintenance at 352-392-0081 Email: addvendor@ufl.edu (use this address if you need assistance with these forms) Note: This application is valid for one year from last payment or application date, whichever is later. A W-9 must be attached to process this application. Name of Business or Payee Date of Application Part 1 – Contact Information Main Address Remit Address City State City State Zip Business Phone Number Zip Contact Person Contact Phone Number Business Fax Number (if different from business number) Business Website Contact Email Part 2 – Small and/or Minority Status Information – Check all that apply A. B. FEDERAL CLASSIFICATIONS SBA 8(a) Certification Small Disadvantaged Business Certification HUBZone Certification Veteran Service Disabled Veteran Vietnam Veteran Women Owned Minority-Owned Business STATE OF FLORIDA CERTIFIED MINORITY BUSINESS ENTERPRISES (CMBE) African American NON-CERTIFIED MINORITY BUSINESS ENTERPRISES (NMBE) African American Hispanic Hispanic Minority Employees Asian/Hawaiian Native American American Woman Asian/Hawaiian Native American American Woman Minority Community Served Other Non-Profit NON-PROFIT ORGANIZATION Minority Board of Directors Check all that apply If you select a classification that is certified by a Federal or State agency, please supply your certification numbers and expiration dates for each certification and the agencies along with this application. To determine your Federal Size Standard, please access the U.S. Small Business Administration’s web site (http://www.sba.gov/smallbusinessplanner/) or the SBA’s Size Standards web site (http://www.sba.gov/size/) to look up your North American Industry Classification System (NAICS) Code and the qualifying number of employee’s or annual dollar amount. If you are using Federal Size Standards, please specify the codes used: NAICS CODE: Number of Employees: OR Annual Amount: $ Part 3 – Purchase Order and Payment Preferences By which delivery method do you prefer to receive purchase orders? Fax Email Payment Discount Terms: 2% Net 10 Other: ___________________________ By which delivery method do you prefer to receive payment? Check EFT (To receive payment by Electronic Funds Transfer, please complete the attached form and submit to the address) VISA ePayables (You will be contacted by University Disbursement Services staff) Part 4 – Additional Payment Information and Signature I certify that the information supplied herein is correct to the best of my knowledge. Name of Person Completing/Authorizing Application Title of Person Completing/Authorizing Application Signature of Person Completing/Authorizing Application Date FA-PDS-UFVA 03/2010 Vendor Application - University of Florida You may fill these forms out on-line, print them, and send them by mail, fax or email to Vendor Maintenance: Mail: University of Florida, Attn: Vendor Maintenance, PO Box 115350, Gainesville, FL, 32611-5350 Fax: Attn: Vendor Maintenance at 352-392-0081 Email: addvendor@ufl.edu (use this address if you need assistance with these forms) Note: This application is valid for one year from last payment or application date, whichever is later. A W-9 must be attached to process this application. Name of Business or Payee Date of Application Part 1 – Contact Information Main Address Remit Address City State City State Zip Business Phone Number Zip Contact Person Contact Phone Number Business Fax Number (if different from business number) Business Website Contact Email Part 2 – Small and/or Minority Status Information – Check all that apply FEDERAL CLASSIFICATIONS SBA 8(a) Certification Small Disadvantaged Business Certification HUBZone Certification Veteran Service Disabled Veteran Vietnam Veteran Women Owned Minority-Owned Business A. B. STATE OF FLORIDA CERTIFIED MINORITY BUSINESS ENTERPRISES (CMBE) African American NON-CERTIFIED MINORITY BUSINESS ENTERPRISES (NMBE) African American Hispanic Hispanic Minority Employees Asian/Hawaiian Native American American Woman Asian/Hawaiian Native American American Woman Minority Community Served Other Non-Profit NON-PROFIT ORGANIZATION Minority Board of Directors Check all that apply If you select a classification that is certified by a Federal or State agency, please supply your certification numbers and expiration dates for each certification and the agencies along with this application. To determine your Federal Size Standard, please access the U.S. Small Business Administration’s web site (http://www.sba.gov/smallbusinessplanner/) or the SBA’s Size Standards web site (http://www.sba.gov/size/) to look up your North American Industry Classification System (NAICS) Code and the qualifying number of employee’s or annual dollar amount. If you are using Federal Size Standards, please specify the codes used: NAICS CODE: Number of Employees: OR Annual Amount: $ Part 3 – Purchase Order and Payment Preferences By which delivery method do you prefer to receive purchase orders? Fax Email By Payment Discount Terms: 2% Net 10 Other: which delivery method do you prefer to receive payment? Check EFT (To receive payment by Electronic Funds Transfer, please complete the attached form and submit to the address) VISA ePayables (You will be contacted by University Disbursement Services staff) Part 4 – Additional Payment Information and Signature I certify that the information supplied herein is correct to the best of my knowledge. Name of Person Completing/Authorizing Application Title of Person Completing/Authorizing Application Signature of Person Completing/Authorizing Application Date PLEASE READ AND CAREFULLY FOLLOW INSTRUCTIONS! For a Start or Change of electronic payment all boxes must be completed. Do not leave information blank! Please leave this area blank This form will start, change, or stop electronic payment for all payments received by you from the University of Florida. This does not apply to employee salary payments. UNIVERSITY OF FLORIDA ELECTRONIC PAYMENT AUTHORIZATION Michael V. McKee, University Controller PLEASE TYPE Name: Please be sure your last name on this form matches the last name on the W-9 on file with Purchasing and Disbursement Services Office. Your electronic payment will not start if the last names do not match. Action Requested: (1) Check Start if you don't have electronic payments and wish to. (2) Check Change if you have electronic payments and wish to change your financial institution or just your account number or account type (checking or savings). Your current electronic payment is stopped when a change request is received. While the change is being processed, you will be paid by warrant (check). (3) Check Stop if you wish to stop your electronic payment. (4) Check Name Change Only if you are changing only your name to correspond to your W-9. Complete the top portion of the form and sign and date it. OR PRINT CLEARLY Your Tax Identification Number Legal Name Address (Number, Street) Account Number: Please make sure the account number written on this form is correct. If you are not sure, PLEASE CONTACT YOUR FINANCIAL INSTITUTION. City State Zip Code Transit Routing Number: This is the nine-digit number that identifies your financial institution. It is found in the bottom left-hand corner of your checks. Telephone Fax ( ( ) (1) Start (2) Change (3) Stop (4) Name Change Only (1) Checking (2) Savings ) Action Requested (Check Only One) Account Type (Check Only one) AGREEMENT I hereby authorize and request the University of Florida to initiate credit entries and, if necessary, a debit entry in accordance with NACHA rules reversing a credit entry made in error, to my account at the financial institution named. The electronic payment data remains in effect until withdrawn by: Your Account Number Transit Routing Number of Your Financial Institution (a) Written notification to the University; (b) death or legal incapacity; (c) the financial institution or (d) the University of Florida. Special Note: Please make sure your electronic payment has stopped before closing your account. Otherwise, the funds will be returned to the University and cause a delay before you receive your payment in the mail. Please note that in order to add your EFT information we must have one of the three forms of back up: Name of Your Financial Institution 1). A voided check which confirms the account/routing number on your form. 2). A signed letter from a bank representative on bank letter head which lists and confirms the account/routing number 3). A signed letter from the company's CFO/owner on company letter head which lists and confirms the account/routing number. Telephone Number of Your Financial Institution ( ) Signature Date Email address for Remittance Advice THIS FORM MUST BE SIGNED AND DATED BY PAYEE Signature above signifies acceptance of the terms and conditions in the AGREEMENT to the right. FA-PDS-UFVA 01/2015 Please return completed form with a voided check attached to: Fax: 352-392-0081 E-mail: addvendor@ufl.edu Or mail to: University of Florida ATTN: Vendor Maintenance PO Box 115350 Gainesville, FL 32611-5350 Telephone: (352) 392-1241
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