Intel Supplier Name Change Form
Important: This form must be submitted on your company letterhead. If your address has
changed, please submit an Intel Supplier Address Change Form.
New Company Name:
______________________________________________________________________
Previous Company Name:
______________________________________________________________________
Company Registration Number:
______________________________________
(For Malaysian Suppliers only)
Intel Supplier Number (if known):
__ __ __ __ __ __ - __ __ __
TIN Number: __ __ - __ __ __ __ __ __ __ -OR- Social Security #: __ __ __ - __ __ - __ __ __ __
If the above Tax Identification number has changed, from either a Social Security or TIN #, fill-in the following:
Previous TIN Number : __ __ - __ __ __ __ __ __ __ -OR- Previous Social Security #: __ __ __ - __ __ - __ __ __ __
Effective date of change(s):
_____ - _____ - _____
Month
Day
Year
Check Reason For Change (Required):
TIN Filing Status (Required):












Name change
Merger
Bought out
Tax Identification Number (TIN) Change
TIN Filing Status Change
Other: ________________________________
Authorized Signature _______________________________
Individual, Sole Proprietor
Partnership – including LLC or LLP
Incorporated Attorney or Law Firm
Corporation/Incorporated
Non-Profit
Government Agency
Date
_____ - _____ - _____
Month
Day
Year
Name (please print)
_______________________________
Title _______________________________
Phone Number
(_______)_______________________
E-mail ______________________________
Please return this completed form and a copy of Form 13 (Form 13 is applicable to Malaysian Suppliers only) to
your Intel Buyer. For assistance please contact your Buyer, their name and phone number is on your Intel
purchase order.