Signed by TITLE: FIRM: TELEPHONE NO: ADDRESS: DATE: CITY: STATE: ZIP: FEDERAL I.D. NO. OR SOCIAL SECURITY NO.: Eastern Kentucky University requires a Federal Tax Identification number or Social Security number for all vendors or persons doing business with the University in order to comply with Federal Regulations and tax reporting requirements. Please take a few minutes to fill out this information and return to us to ensure prompt payment of your invoices. Thank you for the valuable service you have provided Eastern Kentucky University, and we look forward to a long and lasting relationship. IF SENDING A W-9, PLEASE RETURN THIS FORM ALSO. For your convenience, you may return the information one of the following ways: FAX: Attn: ▇▇▇▇▇ @ ▇▇▇-▇▇▇-▇▇▇▇ E-Mail: ▇▇▇▇▇.▇▇▇▇▇▇@▇▇▇.▇▇▇ Facilities Management Mail: Purchasing Division Eastern Kentucky University ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ Phone: ▇▇▇-▇▇▇-▇▇▇▇ Commonwealth 1411 Richmond, Kentucky 40475 Phone # (▇▇▇)▇▇▇-▇▇▇▇ Please type or print legibly Name of Firm * (Company or Individual) Phone Number * Make Checks Payable To * Address * Fax Number * Payment Address * Address Web Site Address or E-mail Payment Address Address Vendor Representative Name on Invoice * City * State * Zip* Federal Tax ID Number ** Social Security Number ** Willing to accept ACH payments * Yes No Bank Routing # Bank Account # Willing to accept credit card payments* Yes No Payment Terms * VENDOR INFORMATION * required fields **Federal Tax ID Number- This field must be completed if “Name of Firm” is a company name. Social Security Number- This field must be completed if “Name of Firm” is an individual’s name. CERTIFICATION Under penalties of perjury. I certify that:
Authorised Signatories means any two authorised officers of the Issuer signing jointly.
Authorised Signatory means, in relation to any Obligor, any person who is duly authorised and in respect of whom the Administrative Agent has received a certificate signed by a director or another Authorised Signatory of such Obligor setting out the name and signature of such person and confirming such person’s authority to act.
Wrongdoing means a violation, which is not of a merely technical or minimal nature, of a federal
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