Xerox Business Services, LLC
Supplier Profile Form (Form W-9)
1. Please create a username and password for your company to be able to view status of invoices at Xerox Business Services, LLC:
(Apostrophes will be removed)
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2. Supplier Information  (See help and guidelines)
(* Required Fields)
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http://
  
  
  
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* (check one) Corporation   Partnership   Sole Proprietorship   Individual
  Trust/Estate   Government Agency   Non-Profit Organization   
  Foreign Owned  
What type of services do your vendor perform?
* (Check all that apply)
:
Hardware
Software
Temporary Staffing Firms
Recruiting & Permanent Agencies
Health & Benefits
Independent Contractor
Subcontractors & Consultants
Travel & Hospitality
Office Products & Services
Print & Mail
Legal/Law Firms
Facilities, Maintenance, Security
Rent
Utilities
Government Entities
Other
3. Addresses
PO Mailing Address:*
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Xerox Business Services, LLC preferred method of payment (ACH) Prefer payment by check?  
ACH (Payment) Information:
4. Administrative Contacts
Purchase Contact Information* Payment Contact Information   Same as Yours
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5.  Please enter your Supplier Diversity Information
Minority Business Enterprise (MBE)
Disadvantaged or Minority Business Representation - Supplier represents that its qualifying ownership falls within at least one of the following categories. * (Check all that apply) :
Asian-Pacific American
African/Black American
Historical Black College and University/Minority Institute
Subcontinent Asian
Individual Concern
Combined Ethnic Group Ownership
Hispanic American
Native American
     For the above categories, please provide your National Minority Supplier Development Council certification information:
     
Service Disabled Veteran Enterprise (SDVE)
     For the above categories, please provide your Association of Service Disabled Verterans certification information:
     
Woman Owned
     For the above categories, please provide your Women's Business Enterprise National Council certification information:
     
None of the above
* (check one)
Large Business
Small Business
Small Disadvantaged Business (U.S. Department of Education category)
None of the above
     For the above categories, please provide your Small Business Administration 8a certification information:
     
Certified HUBZone Small Business Concern list (Check all that apply)
Federally-certified on HUBZone
     
State-certified on HUBZone
      Enter State of certification (Hold Ctrl* key to select multiple states)          Enter Date of certification



To be included in the Xerox Business Services, LLC Supplier Diversity Program you must supply validation of your diverse status. Certification documents from the following qualified agencies are acceptable:

  • National Minority Supplier Development Council (NMSDC) or its regional affiliates
  • Women’s Business Enterprise Council (WBENC)
  • United States Small Business Administration (SBA) – 8a/SDB Programs
  • Local, State, or Federal Government Agencies

Mail copies of your current Third-Party Certifications to the Xerox Business Services, LLC Supplier Diversity Office at the following address:

Xerox Business Services, LLC
Supplier Diversity Office
2828 North Haskell Avenue
Building 1, 8th Floor
Dallas, TX 75204

For more information about Xerox Business Services, LLC Supplier Diversity Program, please email supplierdiversity@acs-inc.com.

 

6. Supplier Industrial Codes
  
7. Supplier Approval Routing
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