Appalachian State University
Contract No.
Standard Contract for Independent Personal Services
1. Contract Information
Contract between Appalachian State University (Dept)
and (Full Legal Name)
Citizenship: Contractor is a U.S. Citizen or Permanent Resident Alien
Banner ID
✔
YES
SSN/ TIN:
NO
or ITIN
Mailing or Remit to Address:
City
State
Phone#
Zip
Fax:
Email:
2. Details of Services Provided
For services as described below:
Date(s) of Service:
Time(s) of Service:
Location of Work is in the United States
Location Work Performed:
YES
Contract Services Amount:
NO For services performed in the U.S. please click here and refer to One Time Payments to Short Term International Visitors
Payment Date:
Payments are subject to applicable Federal and State Income Tax laws. Payments may also be subject to Federal or State
withholding. An individual contractor is considered self‐employed and is responsible for their own Social Security taxes in
addition to applicable Federal and State taxes.
3. Accounting Information
1.
2.
3.
4.
Fund
Fund
Fund
Fund
Account
Account
Account
Account
Amount
Amount
Amount
Amount
Total
0.00
4. Approvals
Individual
Date
Dean/ Director
Date
Project Director
Date
Controller
Date
Additional Approval
Date
Additional Approval
Date
This contract is not valid unless signed by the University Controller or that official's designee.
This form is not a payment form and is required to be signed and submitted for approval before any payment is made or
services completed. This form must be attached to the Request for Direct Payment form in order for payments to be
disbursed.
Appalachian
State
University
Please fax or mail completed form to:
Vendor Information Form
Appalachian State University
Substitute W9
Controller's Office (IRS Compliance)
ASU PO Box 32125
**Please Print or Type**
Boone, NC 28608
Fax: (828) 262-3297
In order to properly establish new vendors and individuals in our financial system, and to comply with Internal Revenue Service (IRS) regulations and North
Carolina State Law, we are required to obtain the Social Security Number (SSN) or Federal Tax Identification Number (TIN, EIN, or ITIN) to satisfy Form 1099
reporting requirements and University Policy. Failure to provide this information when requested may cause delay in payment and may subject all payments
made to you or your organization to the 28% backup withholding as required by the IRS.
Legal Business Name
Legal Name (as shown on your
income tax return)
First
Middle
Last
Partnership
Exempt Organization, 501 (C) 3
Individual/ Sole proprietor
Corporation
Limited Liability Company (LLC);
Enter the LLC tax classification (C=corporation, P=Partnership, D=Disregarded)
Social Security Number
or
Federal Taxpayer Identification Number
IMPORTANT: Out-of-State Vendors: Please include your NC Secretary of State Authority Number
Address (Business or Individual)
Invoice Remittance Address
Area Code/ Phone:
Area Code/ Fax:
E-mail Address
Area Code/ Phone:
Area Code/ Fax:
E-mail Address
Ownership, Control & Size Status (Public Law 95-507)
Minority
Women
Disabled
Disabled Owned Business
Owned
Owned
Owned
Enterprise
Certification: Under penalties of perjury I certify that: (1) I am duly authorized to complete this form; (2) the number shown on this form is the
correct taxpayer identification number; (3) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I
have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest
or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and (4) I am a U.S. citizen or other U.S. person as
defined by the IRS.
Signature:
Date:
Title
Appalachian State University
Controller's Office (Accounts Payable)
Phone: (828) 262-2110
Fax: (828) 262-3297
Rev. 2010
Appalachian State University
Independent Contractor/Employee Checklist
For tax purposes, a service provider is either an employee (paid through Payroll) or an independent contractor (paid through Accounts Payable). This
checklist incorporates IRS guidance on worker classifications to help determine the appropriate classification. If you have any questions or would like
assistance in making classification decisions, please contact the Controller's Office at x2110.
YES
NO
N/A
1 Is the individual on record as a current employee of the University or any other NC state agency?
2 Is it expected that the University will hire this individual as an employee following the termination of this work?
3 During the 12 months prior to this work, was the individual a University employee?
4 Does the University provide the individual with instructions as to when, where, and how the work is to be performed?
5 Does the University provide training to the individual?
6 Does the University require the individual to submit interim reports?
7 Does the University pay for the individual’s business and travel expenses?
8 Does the individual have an investment in their own business?
9 Does the individual make their services available to other relevant markets?
10 Is the individual paid by the hour, week or month?
11 Can the individual recognize a profit or loss from the services performed?
12 Does the University have a written contract with the individual for the services being performed?
13 Is the work being performed a key or integral part of the regular business of the University?
13a If the work is teaching, lecturing and/or instructional related, is the work associated with a for-credit class?
14 Can the University refuse payment to the individual for unsatisfactory work?
TO BE COMPLETED BY THE DEPARTMENT
Service Provider Name:
Description of Services to be Provided:
Time period of Service and/or Number of Days Service Provided:
Form Completed By:
Date:
TO BE COMPLETED BY THE CONTROLLERS OFFICE
Determination:
Independent Contractor
Employee
Notes:
Determination Made By:
Independent Contractor/Employee Checklist
Date:
Updated 5-27-11
**OPTIONAL**
Banner ID:_________________
Appalachian State University
Vendor Electronic Payment Form
Return to: Controller’s Office
Address: ASU Box 32125
Boone, NC 28608
Telephone: 828-262-2110
Fax: 828-262-3297
For your convenience and benefit, Appalachian State University offers payees the opportunity to
receive future payments electronically, rather than by check. Your payments will be deposited
into the checking or savings account of your choice. In addition to having the money deposited
electronically, you also will be notified of the deposit by e-mail. The e-mail will provide you with
all the information that would normally be on your check stub. To receive payments
electronically, you must print, complete this form, and return both to the address above.
PRINT the following information.
Payee Name:
 E-mail address:
Federal ID #/SSN #:
 FAX
Bank Name:
Authorized By
Bank Routing Number:
Print Name:
 Checking Acct #:
Title:
 Savings Acct #:
Date:
Number:
I acknowledge that electronic payments to the designated account must comply with the provisions of U.S. law, as
well as the requirements of the Office of Foreign Assets Control (OFAC). Check one of the following:

I affirm that the entire amount of any direct deposit payments made by Appalachian State University to the financial institution
and account that I have designated; are not subject to being transferred to a foreign bank account.

I affirm that the entire amount of any direct deposit payments made by Appalachian State University to the financial institution
and account that I have designated; are subject to being transferred to a foreign bank account. I also understand that
the University may elect to remit future payments to me via paper check instead of electronically.
I authorize Appalachian State University to initiate direct deposit entries each pay period, and if necessary, adjustments for any
direct deposit entries in error, to the financial institution and account identified on the attached certification document. I understand
and accept the conditions of participation in the direct deposit program. This authority will remain in effect until I cancel it in writing.
SIGNATURE:
DATE: