Instructions

Please visit our video: How to fill out the 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).
• New taxpayer identification number.

PART A - Contact Information:

• Mailing Address – Please indicate the address you wish to receive remittance and/or correspondence.
• Name – The person named here will be contacted to approve any future changes regarding payments and your registration. Note: 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 Social Security Number (SSN) OR Employer Identification Number (EIN).

Do NOT provide both.

• If using the PDF version, please sign with a pen (a “wet signature”). Stamped, Inserted or Electronic Signatures will NOT be accepted.