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Vendor Information and Certification

  1. About This Form
    The City of Edina's Finance Department requires those receiving payment from the City to provide a W9 and up-to-date financial contact/Remit To information. For more information about why the City of Edina is collecting this information or to ask questions, contact Accounting Clerk Lonnia Jefferson at 952-826-0411 or ljefferson@EdinaMN.gov.
  2. Use This Form To:
    DO NOT INCLUDE bank routing or financial account numbers with this form
  3. Please use ALL CAPS
    Please use ALL CAPITAL LETTERS when filling out the form fields.
  4. Provide W9 Information
    Please have your W9 in front of you and input the information EXACTLY as it appears on your W9. (Remember to use ALL CAPS)
  5. No dashes
  6. Most common file types accepted including JPG, PDF, DOC, DOCX, TIF, etc.
  7. If you received a letter from the City of Edina's Finance Department requesting you fill out this online form, please input the company name that the letter and/or envelope was addressed to (Example: Lunds & Byerlys). This will help us match up records already in our system.
  8. Financial Contact
    We will contact you separately for banking information. Please list the proper contact for banking/payment receipt information who has the authority to change the remit address.
  9. Please format with dashes as above
  10. Electronic Payments*
    Are you interested in payments being made to your business electronically? (Yes or No)
  11. Remit To Information*
    Is the Remit To the same information as listed on your W9?
  12. Please format with dashes as above
  13. Other Contacts
  14. Accounts Receivable Contact*
    Is there an A/R contact other than the person(s) already listed on this form?
  15. Please format with dashes as above
  16. Other Contact*
    Is there another contact you would like to provide, such as in sales or customer service, that would be a contact for financial information?
  17. Please format with dashes as above
  18. Certifications
    Please check any applicable certifications, supply last certification date and upload a copy of your certifications obtained through the Minnesota United Certification Program, the Office of State Procurement (OSP) or the Central Certification Program (CERT).
  19. Certification Type
    Check all that apply
  20. If you marked "Other" certification type, please provide a brief explanation and upload proof in the upload section below.
  21. Please list last certification date for any of the certifications you checked.
  22. Use if you have more than one
  23. Questions?
    For questions regarding this form or the vendor payment process, contact Accounting Clerk Lonnia Jefferson at 952-826-0411 or ljefferson@EdinaMN.gov.
  24. Public Records Notice*
    Some information you provide on this form, such as your business' certification type, is considered public record and would be released upon request. W9s and financial information are not public records and would not be released.
  25. Leave This Blank: