Supplier Profile Form Instructions

(INCOMPLETE FORMS MAY CAUSE DELAY ON PAYMENTS)

The following information provides general guidance in completing the Supplier Profile Form.  You should also refer to the IRS instructions for the W-9 (www.irs.gov).

 

1.        USER NAME AND PASSWORD

·                      Input a user name and password.  This will enable the supplier to view status of invoices after supplier has been set-up in the system

 

2.        SUPPLIER INFORMATION

·          Supplier Name – Name of the suppler that needs to be set up in the system

·          Name of Tax ID Number User – If the name for the Tax ID # is different than the Supplier Name please enter it here.

·          Taxpayer ID Number (SSN) -  suppliers tax id or social security number

·          TIN or SSN – Need to determine if the number provided is a Social Security Number or Tax Identification Number

·          Dun & Bradstreet Number - Unique nine-digit code

·          Parent Business Name – Supplier’s Parent Company, if applicable.

·          Related Parties -  You are considered to be a Related Party to Xerox Business Services, LLC if you meet any of the following:  (1) Affiliates of Xerox Business Services, LLC - a party that, directly or indirectly through one or more intermediaries, controls, is controlled by, or is under common control with Xerox Business Services, LLC, (2) an entity for which investments are accounted for by the equity method by Xerox Business Services, LLC, (3) trusts for the benefit of employees, such as pension and profit-sharing trusts that are managed by or under the trusteeship of management, (4) principal owners of Xerox Business Services, LLC - owners of record or known beneficial owners of more than 10 percent of the voting interests in Xerox Business Services, LLC,  (5) its management - persons who are responsible for achieving the objectives of Xerox Business Services, LLC and who have the authority to establish policies and make decisions by which those objectives are to be pursued and, (6) members of their immediate families, (7) other parties with which Xerox Business Services, LLC may deal if one party controls or can significantly influence the management or operating policies of the other to an extent that one of the transacting parties might be prevented from fully pursuing its own separate interests, (8) a party that can significantly influence the management or operating policies of the transacting parties or if it has an ownership interest in one of the transacting parties and can significantly influence the other to an extent that one or more of the transacting parties might be prevented from fully pursuing its own separate interests

·          Type of Business– Supplier’s federal tax filing status.

·                      If Supplier is Foreign Owned, list Country.  The supplier’s country of origin is required if foreign owned.

 

3.        ADDRESSES

·          Mailing Address is required for communication purposes

·          Remit to Address is required for payment purposes

·          New or Change of Address – this is required to identify if this is a new address to be set-up in the system or a change to an existing address on file.

4.        ADMINISTRATIVE CONTACTS

·          Your  Contact Information – The contact information of the individual filling out the Supplier Profile Form.

·          Billing Contact Information – Individual at Supplier’s organization that would be responsible for billing inquiries.

 

5.        SUPPLIER DIVERSITY INFORMATION

 

Disadvantaged or Minority Business Representation In order to qualify as a MWDBE, the company must be fifty-on percent (51%) owned, operated and controlled by a minority (s) or woman/women as defined below.

·          Asian-Pacific American – U.S. Citizen with origins from Japan, China, the Philippines, Vietnam, Korea, Samoa, Guam, the U.S. Trust Territory of the Pacific Islands (Republic of Palau), the Northern Marina Islands, Laos, Kampuchea (Cambodia), Taiwan, Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Republic of the Marshall Islands, Or the Federated States of Micronesia, Macao, Fiji, Tonga, Kiribati, Tuvalu, or Nauru

·          African/Black American – U.S. Citizen

·          Subcontinent Asian (Asian-Indian American) – U.S. Citizen with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal

·          Hispanic American – U.S. Citizen with origins from South America, Central America, Mexico, Cuba, the Dominican Republic

·          Native American – American Indians, Eskimos, Aleuts, or Native Hawaiians, including Indian tribes or native Hawaiian organizations

·          Combined Ethnic Group Ownership – Two or more minority groups

·          Individual/concern – currently certified for participation in the Minority Small Business and Capital Ownership Development Program under section 8(a) of the Small Business Act (15 U.S.C. 637(a))

·          Service Disabled Veteran – As defined in Public Law 106.50

·          Woman - Owned – Entity with at least 51% ownership by a woman who is a US citizen and operates and controls the business.

·          None of the above – Not a disadvantaged or minority business

 

Large, Small, and Small Disadvantaged Business definitions

·          Large Business Concern – Other than small

·          Small Business Concern – A Small Business Concern, including its affiliates, which is independently owned and operated, is not dominant in the field of operation in which it is competing and can further qualify under the criteria concerning the number of employees, average annual receipts, or other criteria as defined by the Small Business Act 3 and relevant regulations promulgated pursuant thereto. (See Code of Federal Regulations, title 13, Part 121, as amended, which contains detailed industry definitions.

·          Small Disadvantaged Business Concern – By checking the appropriate box on the front of this form, Supplier represents and certifies that it is a small disadvantaged business concern as defined by the Small Business Administration (SBA) on the SBA PRO-Net database.

·          None of the above – None of the above is applicable to supplier.

 

HUBZone – For additional information regarding HUBZone see the internet http://www.sba.gov

 

SBA Certification - If certified by the SBA as a small business, or if certified as a minority- or women-owned business, please indicate by whom your company is certified.  Please List:    Certifying Agency, Certification Number, and Expiration Date.

 

 

6.        SUPPLIER INDUSTRIAL CODES

·          NAICS CODES – First four digits of the North American Industry Classification System.  Codes and instructions can be found on the internet at http://www.census.gov/epcd/www/naics.html

·          Supplier Capabilities and Certifications – Please provide a brief explanation of supplier’s product offering and any certifications.

 

 

7.  SUPPLER APPROVAL ROUTING

·          Xerox Business Services, LLC Employee’s Email Address – Supplier must provide the email address of its Xerox Business Services, LLC contact.  This will ensure that the information provided is routed to the appropriate person for approval to be set up in the system.