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?

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?

Type of Change (Check all that apply)

Other

Existing Vendor Number, if known

Existing Vendor Payee Name

Existing Vendor Payee Tax ID

Effective Date of Change

MonthDayYear

Your Name

Is your Legal Entity Name Different From Above?

Organization Name

As shown on tax filings

Doing business as (DBA)

Federal Tax Identification Number Type

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.Format: 0000000000.

Fax Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

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

Are you an out of state vendor?

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 (2026) and upload the completed form below.

Download Form 590 Withholding Exemption Certificate (2026) and upload the completed form below.

Download Form 588 Nonresident Withholding Waiver Request (2026) 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

Are you a Foreign Vendor?

Country of Residence

Are you an Entity or Individual?

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

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

Payment Method

Bank Name

must be based in the United States

Routing Number

Account Number

Name on Account

Type of Account

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

Is your Payment Address different from your Main Address provided in Section A?

Remit Address

Street Address

Street Address Line 2

CityState

Zip Code

Contact Name

Contact Title

Contact Phone Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Fax Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Email

example@example.com

Would you like to add another contact?

Contact Name

Contact Title

Contact Phone Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Fax Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Email

example@example.com

Would you like to add another contact?

Contact Name

Contact Title

Contact Phone Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Fax Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Email

example@example.com

Would you like to add another contact?

Contact Name

Contact Title

Contact Phone Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Fax Number

Please enter a valid phone number in the format 0000000000, no spaces.Format: 0000000000.

Contact Email

example@example.com

List any contacts to remove from account

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

Small Business Designations

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.

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.