SECTION 1. SUPPLIER PROFILE - Aerojet Rocketdyne | At the ...
This form is required of all Suppliers to Aerojet Rocketdyne Holdings, Inc. (AR Holdings), Aerojet Rocketdyne Inc. (AR), Aerojet Ordnance Tennessee, Inc. (AOT), and/or Easton Development Co., LLC (Easton) (collectively referred to herein as “Company”). Any individual or entity paid by Company is considered a Supplier. Information provided on this form is subject to verification, including but not limited to, IRS Tax Identification Number (TIN) Matching. INSTRUCTIONS: (DOUBLE CLICK TO ENTER “X” IN BOXES)For a new request, please mark Section 1 as “Initial/New Request” and complete all sections identified with yellow section heading labels; do not complete sections identified for internal use. To update/modify existing supplier information, please mark Section 1 as “Changes Only” and complete only section(s) with changed information – Supplier represents that all other information not specifically changed remains the same.Supplier Name/Address: Enter address where Company will send Purchase Orders/Agreements (“PO”). If you have multiple locations with a single common remittance account, use the address where we send correspondence.Type of Business: Indicate the legal status of your business (under Section 4 – Taxpayer Information).Taxpayer Information section must be completed for payments to be issued, including Employer/Taxpayer Identification Number (or Social Security Number), or Supplier may substitute IRS Form W-9 for Section 4. IRS FORM W-9 MUST BE ATTACHED.Contact Information: Please provide Business/Sales contact and bank remittance advice contact for electronic plete and return form to Supply Chain: Bldg. 20001/Dept. 3048, PO Box 13222, Sacramento, CA 95813-5000OR Fax to 916-355-3292 OR email to AerojetRocketdyneSupplyChain@SECTION 1. SUPPLIER PROFILE FORMCHECKBOX Initial/New Request FORMCHECKBOX Changes OnlySupplier Legal Name: FORMTEXT ?????Parent Co. Legal Name (if any): FORMTEXT ?????Secondary/Trade Name/DBA: FORMTEXT ?????Secondary/Trade Name/DBA: FORMTEXT ?????DUNS No.: FORMTEXT ?????Parent Co. DUNS No.: FORMTEXT ?????CAGE/NCAGE No.: FORMTEXT ?????Parent Co. CAGE/NCAGE No.: FORMTEXT ?????Street Address (Line 1) FORMTEXT ?????Remit/Payment Address (Line 1) - if different from Address at left FORMTEXT ?????Street Address (Line 2) FORMTEXT ?????Payment Address (Line 2) - if different from Address at left FORMTEXT ?????City & State Code (or Foreign Province, if any): FORMTEXT ????? , FORMTEXT ????? City & State Code (or Foreign Province, if any): FORMTEXT ????? , FORMTEXT ????? County & 9 Digit ZIP Code: FORMTEXT ????? , FORMTEXT ????? County & 9 Digit ZIP Code: FORMTEXT ????? , FORMTEXT ????? Country Code (3 letter ISO code): FORMTEXT ?????Country Code (3 letter ISO code): FORMTEXT ?????Congressional District: FORMTEXT ?????Congressional District: FORMTEXT ?????Email Address (for official correspondence): FORMTEXT ?????Website URL: FORMTEXT ?????Contact Name: FORMTEXT ?????Contact Email: FORMTEXT ?????Contact Phone (with area code): FORMTEXT ?????FAX: FORMTEXT ?????? Company IS incorporated or organized to do business in the United States.? Company IS NOT incorporated or organized to do business in the United States.SECTION 2. BUSINESS SIZE/SOCIOECONOMIC INFORMATION – MUST SELECT ONE OR MOREDefinitions of business sizes are found at: . Navigate to Contracting/Getting Started Contractor/Make Sure you Meet SBA Size Standards. Misrepresentation of business size is a federal crime governed by 15 USC 645(d) , and is punishable by (i) imposition of fine, imprisonment, or both; (ii) imposition of administrative remedies, including suspension and debarment; and, (iii) determination of ineligibility for participation in programs conducted under the Act. Select all that apply:? Foreign-owned business? Government Agency? LARGE BUSINESS? SMALL BUSINESS. If this response is selected, please identify any additional designation(s) from the choices in this section:? HUBZone: Must be CERTIFIED by the SBA () and listed in System for Award Management (SAM) at . Provide copy of certificate.? Self-Certified Small Disadvantaged Business. Register at ? Historically Black College or University/Minority Institution? Service Disabled Veteran-Owned Business? Alaskan Native Corporation (ANC)/Indian Tribe. If 8(a) ANC, check SDB box too.? Veteran-Owned Small Business ? Non-Profit per IRS Code Sect. 501C? Women-Owned Small BusinessSECTION 2. BUSINESS SIZE/SOCIOECONOMIC INFORMATION – ContinuedNAICS CODES: List all North American Industry Classification System (NAICS) codes sold to Company; see ( NAICS Codes and Size Standards). For each NAICS code listed, list corresponding size (small or large) and size standards established by SBA in either millions of US dollars OR number of employees.NAICSSIZE (LG/SM)SIZE STD. ($Mil or # Employees)NAICSSIZE (LG/SM)SIZE STD. ($Mil or # Employees) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SECTION 3. FINANCIAL PROFILEPayment Method:Choose an item.Select Currency (USD):Choose an item.Accept Payment by Credit Card? FORMCHECKBOX Yes FORMCHECKBOX No Bank Name: FORMTEXT ?????Address FORMTEXT ??????City FORMTEXT ????? State FORMTEXT ?????ZIP+4 FORMTEXT ?????Title on Bank Acct. Supplier Remittance Advice Email Address FORMTEXT ????? FORMTEXT ?????Bank Routing/ABA No. (9 Digits) EFT Info.Bank Acct No.Type of AcctPayment Terms FORMTEXT ?????? FORMTEXT ?????? FORMCHECKBOX Checking FORMCHECKBOX Savings FORMTEXT ?????SECTION 4. TAXPAYER INFORMATIONCompany is required to file form 1099 annually with the IRS disclosing reportable payments issued to select suppliers. The information supplied in this section will enable us to determine whether we are required to report any payments issued to you during the reporting year. Non-resident Alien: Complete and attach IRS Form W-8. Foreign Entities: Complete and attach IRS Form W-8BEN-E. Non-resident Alien and Foreign Entities do not need to complete this section.Taxpayer Identification Number (TIN): FORMTEXT ????? FORMCHECKBOX Corporation FORMCHECKBOX Partnership ? FORMCHECKBOX S Corporation FORMCHECKBOX Sole Proprietor – Enter SSN: FORMTEXT ????? FORMCHECKBOX Limited Liability Corp. (LLC) FORMCHECKBOX Other (Tax Exempt Organization or Government Entity): FORMTEXT ?????Tax Reporting Address (Optional) - If applicable, IRS Form 1099 is sent to the Payment Address in Section 1. If an alternate tax reporting address is preferred, enter it below.Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ???Zip + 4*Req’d. FORMTEXT ?????1099 CODE1099 RECIPIENT (Check One - not required for corporations) Call Accounting for 1099 Information01 FORMCHECKBOX Rents (Exclude Corporations)03 FORMCHECKBOX Retiree 06 FORMCHECKBOX Medical & Health (Include Corporations)07 FORMCHECKBOX Non-Employee Compensation (Exclude Corporations)07 FORMCHECKBOX Other Services (Legal, Consultants, Accounting, Maintenance, Engineering, Etc.)Please attach a fully executable Internal Revenue Service (IRS) Form W-9SECTION 5. SUPPLIER SIGNATURE AND CERTIFICATIONCERTIFICATION INSTRUCTIONS. Cross out item 2 below if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 below does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN.Under penalties of perjury, I certify that:1. The Taxpayer Identification Number shown on this form is my correct number (or I am waiting for a number to be issued to me).2. AND I am not subject to backup withholding because: a. I am exempt from backup withholding. b. OR I have NOT been notified by the IRS that I am subject to backup withholding as a result of failure to report interest or dividends. c. OR the IRS has notified me that I am no longer subject to backup withholding. 3. AND I am a U.S. citizen or other U.S. person or if not, I am authorized to provide information required on this form.Supplier agrees to promptly notify Company if any information changes that is subject to certification.?Authorized Supplier Representative Signature: Title: FORMTEXT ?????Authorized Supplier Representative Printed Name: FORMTEXT ?????Date: FORMTEXT ?????Phone: FORMTEXT ?????Supplier Comments: FORMTEXT ?????FOR INTERNAL USE ONLY — TO BE COMPLETED BY COMPANY REQUESTERPurpose of SIR (Maestro):Check all that apply: FORMCHECKBOX Purchasing and/or FORMCHECKBOX Pay or FORMCHECKBOX RFQ ONLY- Active iSupplier User? FORMCHECKBOX Yes. If yes, iSupplier User ID: FORMTEXT ????? FORMCHECKBOX No If No, Activate? FORMCHECKBOX No FORMCHECKBOX Yes- iSupplier Portal Activation: FORMCHECKBOX iSupplier Portal Full Access FORMCHECKBOX Sourcing Supplier FORMCHECKBOX Supply Chain Collaboration PlannerRequested By (Internal Company Employee Name): FORMTEXT ?????Email: FORMTEXT ?????Phone:? FORMTEXT ?????Direct Product or Service:Choose an item.Indirect Product or Service:Choose an item.Site(s) Supplier Supports– Select all that apply: FORMCHECKBOX AR Holdings FORMCHECKBOX AR FORMCHECKBOX Easton LLC FORMCHECKBOX AOTPotential Conflict of Interest? FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX Not Sure If Yes or Not Sure, Explain Below** **Per Company Policy, if internal Company personnel responded Potential Conflict of Interest Yes or Not Sure, explain: FORMTEXT ?????FOR INTERNAL USE ONLY — TO BE COMPLETED BY COMPANY APPROVERSCMM Manager/Category Manager/Business Relationship Manager Approval: FORMCHECKBOX APPROVED OR FORMCHECKBOX NOT APPROVED (Provide reason below)Signature:Printed Name:Review Date:Internal Review Comments: FORMTEXT ?????FOR INTERNAL USE ONLY — TO BE COMPLETED BY SUPPLIER ADMINISTRATORABC Date (If any Gov’t POs): FORMTEXT ?????ABC Expiration Date: FORMTEXT ?????DDTC Expiration Date: FORMTEXT ?????Entered By: FORMTEXT ??????Date: FORMTEXT ?????Comments: FORMTEXT ?????Supplier Administrator: Enter assigned supplier number in field at top of form. ................
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