Please complete BOTH pages of this registration form so that we may begin the registration process for you. Upon receipt, we

will enter your data into the NYS Financial System’s centralized vendor database where it will be reviewed, approved and assigned a 10-digit Vendor ID Number. You will then be contacted by the NYS Vendor Management Unit (via email or letter) to advise of your ID number. UB will also be advised of your ID Number and we will begin processing your PO, contract or payment at that time. If you are already registered with the NYS Financial System, enter your Vendor ID Number:

Please provide authorized signature where required (electronic signatures are acceptable). For instructions on completing Section A, form W-9, go to www.irs.gov . Return your completed document to the requestor as noted.

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SECTION A: Vendor/Taxpayer Information and Certification Complete all info & sign where indicated

*If you check the LLC box, you are required to enter your tax classification here

UB Procurement Services 224 Crofts Hall, Buffalo, NY 14260 Fax # 716-645-2687

The New York State Office of the State Comptroller requires all NYS payment recipients to be registered in their new Financial System database. No financial transactions (PO’s - Contracts - Payments) can proceed between any NYS Agency and any vendor until this registration process is completed and a 10-digit Vendor ID Number has been assigned.

For more information on this topic, go to http://www.osc.state.ny.us/vendors/vendorguide/guide.htm

The new NYS Financial System features an online Vendor Self-service Portal where vendors are encouraged to periodically review their data and to update addresses, phone number, etc. whenever necessary. Please use this section to identify a contact person to manage your vendor data. *Note that a Contact Name is required information.

*Contact Name: ___________________________________________________ Title: _____________________________________

Contact’s Email Address: ________________________________________ Phone ( ) ______________________ Ext.________

Vendor’s Website: http://www____________________________________________________________________________________________

Purchase Orders:

Phone Number (_____)____________________________

PO Fax Number (_____)___________________________ PO Email Address __________________________________________

□ Submit PO’s to address listed on the W-9 form -OR- □ Submit PO’s to this alternate address ▼

___________________________________________________

___________________________________________________

___________________________________________________

Payment:

□ Remit payment to address listed on the W-9 form -OR- □ Remit payment to this address ▼

___________________________________________________

___________________________________________________

___________________________________________________

Business Type: □ Small Business (under 500 employees) -OR- □ Large Business (over 500 employees)

Classification: □ Woman-Owned □ New York State Certified Woman-Owned

□ Minority-Owned □ New York State Certified Minority-Owned

□ Veteran-Owned □ Service Disabled Veteran-Owned

□ Disadvantaged □ Historically Black College/University or Minority Institution

□ HUBZone □ Not-for-Profit

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SECTION B: Vendor Contact Information Person authorized to maintain data on the self-service portal

SECTION C: Vendor Preferences Complete this section as applicable

SECTION D: Vendor Profile Check all that apply