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Supplier Profile Form


* - Indicates a required field.
- Click to see a field definition.
Company Information
Company Name *
Business Name, or DBA *
Owner *
Street Address *
City *
State *
Zip *
Telephone *
Fax  
 
Contact Name/Title *
Contact Telephone *
Contact E-mail *
 
Send Payment To (as appears on your invoice) *
Payment Terms  
Freight Terms *
F.O.B. *
Available Products/Services * Please choose "Other" if none of these services properly describe what you offer...
Enter a Specific Service: *
 
Type of Ownership * LLC
    LLC Corporation
    LLC Individual
    LLC Partnership
Corporation
Partnership
Sole Proprietor
Other (specify)
Employer identification number *
If Sole Proprietor and/or Individual, enter the SSN  
American Owned   Yes   
No (specify)
Union Represented   No   
Yes (specify)
Business Size
(if unsure, contact the
Small Business Administration)
  Large   
Small
Number of Employees  
How long in business?  
 
Do you collect Sales Tax? * No
Yes 
If "Yes", please provide the following information:
CA - State Tax No.  
AZ - State Tax No.  
NV - State Tax No.  
City  
City Tax No.  
 
Diverse Suppliers
Please check the applicable category(ies):   Minority owned:
      Black American
      Hispanic American
      Native American
      Asian Pacific American
Women owned
Disabled Veteran owned
Other Groups
Certification
If Diverse Supplier certified, provide the following information and attach a copy of certification(s):
Certification Agency  
Certification No.  
Expiration Date  
Certification Agency Telephone  
Certification Agency City  
Certification Agency State  
 
W-9
This application is not the official IRS form W-9. The information collected below will be used to electronically complete the W-9 form whose format can be viewed by clicking the "W-9 in PDF" link at the bottom of this application. The most current version of this form can be found at www.irs.gov. Please note that by opening this link you are leaving a secured website.  By opening this link, you agree to hold harmless Southwest Gas Corporation, its officers, directors, employees, agents, contractors, and representatives from any claims or damages of any kind arising or resulting from the use or access to the linked website.
Name (as shown on your income tax return) *
Business name, if different from above  
Check appropriate box * Individual/Sole Proprietor
Corporation
Partnership
Other
Limited liability company.
      Enter the tax classification.
     
Address (number, street, and apt. or suite no.) *
City, State, and Zip code *
List account number(s) here  
 
Taxpayer Identification Number (TIN) *
Social security number  
Employer identification number  
 
Southwest Gas (Southwest) Code of Business Conduct & Ethics - Supplier acknowledges that it must read, understand and comply, to the extent applicable, with Southwest's Code of Business Conduct & Ethics (Code) when performing work for, or when transacting business with, Southwest. The Code may be found at www.swgas.com/investorrelations/documents/codeconduct.pdf. The term "Supplier" shall be given its broadest meaning and shall include any vendor, contractor, subcontractor or any other such provider of services and/or products to Southwest.
Check this box if you certify that all of the above is correct. *
Applicant Signature (Please type full name) * X
Date   04/20/2014
 

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Form Definitions
W9 in PDF
 
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