Vendor Payee Information Form

VENDOR PAYEE INFORMATION FORM

COUNTY OF MARIN
Department of Finance - Accounts Payable
3501 Civic Center Drive Suite 219
San Rafael, CA 94903

Which payee type best describes you or your organization?*

PT1 - Vendor receiving payment for goods or servicesPT2 - Government AgencyPT3 - Law Firm receiving legal settlementPT4 - Grant Award recipientPT5 - Resident receiving rebatePT6 - Intern receiving stipendPT7 - Foster Care providerPT8 - Grand Juror receiving stipendPT9 - Employee receiving reimbursementPT10 - None of the above / I'm not sure
Payee Type Abbreviation
Vendor Name
Describe the type of payment you expect to receive.*
Do you need to register as a New Payee or request changes to your existing registration?*

New Payee RegistrationChange Existing Payee Account
Type of Change (Check all that apply)*

Payee Information: Legal Name, Tax ID, Main Address, Main Phone, Main EmailPayment Instructions: Payment Method, Bank Account, Remittance AddressContact Information: Add or Change Individual Contacts’ InformationSmall Business Certification: Add or Change Small Business CertificationOther
Existing Vendor Number, if known
Existing Vendor Payee Name*
Existing Vendor Payee Tax ID*
Effective Date of Change*

MonthDayYear
SECTION A: PAYEE INFORMATION
Your Name*
Is your Legal Entity Name Different From Above?*

YesNo
Organization Name*
As shown on tax filings
Doing business as (DBA)
Federal Tax Identification Number Type*

Social Security NumberFederal Employer ID Number
Social Security Number*
Please enter your Social Security Number in the format 000-00-0000
Federal Employer ID Number*
Please enter your Federal Employer ID Number
Main Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number in the format 0000000000, no spaces.
Fax Number
Please enter a valid phone number in the format 0000000000, no spaces.
Email*
example@example.com
Describe the goods or services your business provides (e.g. legal services, medical services, trade goods, custom printing services, etc.)*
Which county department or special district do you expect to receive payment from?*
Employee ID*
PAYEE IDENTIFICATION AND COMPLIANCE DOCUMENTS
If you don't have a copy of a signed W-9 on the most current IRS form, please fill out a W-9 here and upload below.
Upload Signed W-9*

Allowable file types: pdf, jpg, jpeg, png
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Are you an out of state vendor?*

YesNo
OUT OF STATE VENDORS ONLY
Find out more about California's requirement to withhold tax from certain payments to nonresidents on the Franchise Tax Board website. If you did not provide a physical address within the state of CA, you will need to complete and upload Form 587, Form 590, or a Form 588 Waiver

Download Form 587 Nonresident Withholding Allocation Worksheet (2025) and upload the completed form below.

Download Form 590 Withholding Exemption Certificate (2025) and upload the completed form below.

Download Form 588 Nonresident Withholding Waiver Request (2025) and submit the completed form directly to the Franchise Tax Board. If you are granted a withholding waiver, please upload a copy of that below.
Upload either Form 587, 590 or 588*

Allowable file types: pdf, jpg, jpeg, png
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Are you a Foreign Vendor?*

YesNo
Country of Residence*
Are you an Entity or Individual?

EntityIndividual
Download Form W-8BEN-E Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities) and upload the completed form below.
Upload Form W-8BEN-E

Allowable file types: pdf, jpg, jpeg, png
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Download Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) and upload the completed form below.
Upload Form W-8BEN

Allowable file types: pdf, jpg, jpeg, png
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SECTION B: PAYMENT INSTRUCTION
Payment Method*

EFT/Direct Deposit (preferred)Paper Check
Bank Name
must be based in the United States
Routing Number
Account Number
Name on Account
Type of Account

CheckingSavings
EFT Notification Email
example@example.com
Attach image of Void Check Copy or Account Verification Letter from Banking Institution*

Allowable file types: pdf, jpg, jpeg, png
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Is your Payment Address different from your Main Address provided in Section A?*

YesNo
Remit Address*

Street Address

Street Address Line 2

CityState

Zip Code
SECTION C: CONTACT INFORMATION
Contact Name*
Contact Title*
Contact Phone Number*
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Fax Number
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Email*
example@example.com
Would you like to add another contact?*

YesNo
Contact Name*
Contact Title*
Contact Phone Number*
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Fax Number
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Email*
example@example.com
Would you like to add another contact?*

YesNo
Contact Name*
Contact Title*
Contact Phone Number*
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Fax Number
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Email*
example@example.com
Would you like to add another contact?*

YesNo
Contact Name*
Contact Title*
Contact Phone Number*
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Fax Number
Please enter a valid phone number in the format 0000000000, no spaces.
Contact Email*
example@example.com
List any contacts to remove from account
SECTION D: SMALL BUSINESS CERTIFICATION
Small Businesses and businesses owned by historically disadvantaged entrepreneurs may qualify for certifications from state and federal agencies. These certifications can help your business be more competitive for some types of government and private contracts.

The County of Marin recognizes the following small business certifications:
- Small Business Enterprise Certification (SBE) – California Department of General Services. Small business certification that provides preference for qualified contracts with the State of California.
- Disabled Veteran Business Enterprise (DVBE) – California Department of General Services. Certification for Disabled Veteran business owners.
- HUBZone Business Enterprise (HZBE) – US Small Business Administration. Certification for businesses that operate in federally designated zones. Includes Marin City, Novato, and East San Rafael (Canal).
- Small Disadvantaged Business Enterprise (SDBE) – US Small Business Administration. Small business certification that provides preference for qualified federal contracts.
- Women-Owned Small Business Enterprise Certification (WOSB) – US Small Business Administration. Certification for women-owned small businesses.
If you would like to self-report your business's certification for one of the above designations, please select the type from the list below and provide the certificate details below.
Agency

California Department of General ServicesUS Small Business Administration
Small Business Designations

Small Business Enterprise CertificationDisabled Veteran Business EnterpriseHUBZone Business EnterpriseSmall Disadvantaged Business EnterpriseWomen-Owned Small Business Enterprise Certification
Issue Date

MonthDayYear
Expiration Date

MonthDayYear
FORM CERTIFICATION
CERTIFICATION: I certify that the information provided on this vendor form and applicable attachments is accurate to the best of my knowledge. If any changes occur, I will promptly inform you.*

I agree
Print Name*
Email*
example@example.com
Signature Date*

MonthDayYear
If you need further assistance in completing this form, please call Department of Finance at (415) 473-6156. Request for accommodation may be made by calling (415) 473-4381 (Voice/TTY), 711 for California Relay Service or by e-mail at disabilityaccess@marincounty.gov. Copies of documents are available in alternative formats, upon request.
STAFF SECTION
Assign To*
Notes
Completed Date*

MonthDayYear
Should be Empty:

VENDOR PAYEE INFORMATION FORM

SECTION A: PAYEE INFORMATION

PAYEE IDENTIFICATION AND COMPLIANCE DOCUMENTS

OUT OF STATE VENDORS ONLY

SECTION B: PAYMENT INSTRUCTION

SECTION C: CONTACT INFORMATION

SECTION D: SMALL BUSINESS CERTIFICATION

Small Businesses and businesses owned by historically disadvantaged entrepreneurs may qualify for certifications from state and federal agencies. These certifications can help your business be more competitive for some types of government and private contracts.

FORM CERTIFICATION

STAFF SECTION