W-9 and Vendor Information Form

Thank you for your interest in the city of Kingsport. In order for the Purchasing Department to add you to the vendor data base, please fill out the form below or please download, print, fill out, and fax/mail both your completed Vendor Information Form and W-9 form to:

City of Kingsport
Purchasing Department
225 W. Center Street
Kingsport, TN 37660

Fax: 423-224-2433

Email Address: OliviaNickens@KingsportTN.gov

You may download both forms here or fill out the form below.

W-9 Information

Name (as shown on your income tax return)*

Business name, if different than above

Business Type

Check appropriate box for federal tax classification:*

Individual/Sole Proprietor

C Corporation

S Corporation

Partnership

Trust/Estate

Limited Liability Company

Other

Enter Tax classification*

Exemptions

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg. section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Additional Details

Address*

Street Address City State ZIP Code

Requester's name and address (optional)

List account number(s) here (optional)

Taxpayer Identification Number (TIN)

Social Security Number

Employer Identification Number

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.