Supplier Add Update To be Completed by County Personnel Only. Please do not Send to Suppliers.Date of requestMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Supplier number (required for updates only)Department name(Required)Name of requestor(Required) First Last Phone numberEmail(Required) Which of these are you requesting a change or adding another address to(Required) Remit/payment information Purchase/order information Are you requesting a(Required) Change Additional address Enter OLD Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Enter NEW Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Enter ADDITIONAL address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supplier informationSupplier name(Required)Phone numberFax numberEmail(Required) Contact person(Required) First Last Contact Phone number(Required)Contact Fax numberEmployee Number (If the Supplier is a current employee)Is this a New Submission?(Required) Yes No Address of New Submission(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional informationIn accordance with IRS regulations – Check appropriate box and provide the W-9 or W-8 form completed by the Supplier.(Required) W-9 Request for Taxpayer Identification Number (TIN) W-8 Certificate of Foreign Status Taxpayer Identification Number (TIN)(Required)Select supporting material for W-9:(Required) Invoice Supplier Notice Fax Postal Notice IFB/RFP Form Other Please attach supporting material for W-9(Required) Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 50 MB. Social Security Number(Required)Select supporting material for W-8(Required) Invoice Supplier Notice Fax Postal Notice IFB/RFP Form Other Please attach supporting material for W-8(Required) Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 50 MB. Select supplier type(Required) Corporation Individual/Sole Proprietor LLC Partnership Nonprofit Foreign Corporation Foreign Ind./Sole Proprietor Foreign LLC Foreign Partnership Foreign Government Trust Change Fund Custodian (CFC) Petty Cash Custodian (PCC) Custodial Service Client Respite/Reimbursement Subsidy/Stipend Client Support Order Restitution Order Select Business Category Classification. SMALL, WOMEN-OWNED, MINORITY-OWNED, SERVICE-DISABLED VETERAN, AND EMPLOYMENT SERVICES ORGANIZATION (SWAM) Small Women-Owned Minority-Owned Service-Disabled Veteran Employment Services Organization Non-SWaM Please attach a copy of supporting material for Business Category Classification completed by the supplier Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 50 MB. IF APPLICABLE - Please check appropriate box if the Supplier is receiving payment from the County for one of the following types of goods/services or is a government entity: Rental or Lease of Real Property Risk Management Claims / WC Utilities (electric, water, cable, etc.) Government Entity This form will be returned if the required information is not supplied. All support documentation submitted for this request will be maintained electronically in ORACLE. Please use ORACLE, Supplier Inquiry to view new supplier numbers or to view updated information. This information will be used to prepare year-end tax forms and to satisfy the requirement of VA Code §2.2-4354(2). The information will not be disseminated to third parties unless required by law.
