E&I Contract Patron Application

Institution Information

Institution Name

EIN/TIN

Address

City

State

ZIP

Website Address

Affiliation

Institution Term

2 year	4 year
K-12	N/A

Non-Profit

YesNo

Full Time Equivalent (FTE)

Number of Students(Numeric Only). This is required if you choose “Higher Ed” or “K-12” for Institution Classification.

Institution Classification

If you choose either “Higher Ed” or “K-12”, you must enter Full Time Equivalent(FTE).

Institution Type

SIC Code

The Standard Industrial Classification, SIC code, is a system for classifying industries by a four-digit code. This information will allow us to identify your organization by its industry classification for E&I internal use only.

ERP/Financial System

Does your institution use an eProcurement system?

YesNo

eProcurement System

Contact Information

First Name	Last Name
Title	Department
Primary Role	Phone
Email Address

Referral Information

How did you hear about us?

Please specify

* The above Applicant institution hereby applies for Contract Patron membership with E&I Cooperative Services, Inc. (“E&I”) under the terms and conditions indicated herein, and, if accepted, agrees to abide by the terms and conditions in the By-Laws of E&I. The By-Laws will be forwarded under separate cover, or you may access them at www.eandi.org.

Contract Patron Consent

W-9

The IRS requires E&I to obtain a W-9 from our members with the correct taxpayer identification number and payee information for certain other income paid to you. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable interest, dividends and certain other payments to a payee who does not give a TIN to a payer.

Completed W-9 form may be submitted directly via email to membership@eandi.org.