City of Edina Form Center

2. 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 Accounts Payable Specialist Shirleng Tan Geil at 952-826-0341 or stangeil@EdinaMN.gov.

4. Use This Form To:
   • Submit a copy of your W9
   • Update contact information for those authorized to provide banking information and change the Remit To address
   • Update your Remit To information
   • Provide any other contact information, such as sales, accounts receivable, etc.
   • Provide proof of certifications

   DO NOT INCLUDE bank routing or financial account numbers with this form

6. Please use ALL CAPS

   Please use ALL CAPITAL LETTERS when filling out the form fields.

10. 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)

12. W9 Name*
13. W9 DBA
15. W9 Street Address*
17. W9 City*
18. W9 State*
19. W9 Zip Code*
21. W9 Taxpayer Identification Number*

    No dashes

23. Upload W9 (for verification)*

    Most common file types accepted including JPG, PDF, DOC, DOCX, TIF, etc.

27. 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.

29. Financial Contact Name*
30. Email Address*
32. Address*
34. City*
35. State*
36. Zip Code*
38. Phone Number*

    Please format with dashes as above

42. Remit To Information*

    Is the Remit To the same information as listed on your W9?

    1. Yes
    2. No
44. Remit To Name*
45. Email Address*
47. Address*
49. City*
50. State*
51. Zip Code*
53. Phone Number*

    Please format with dashes as above

57. Other Contacts
59. Accounts Receivable Contact*

    Is there an A/R contact other than the person(s) already listed on this form?

    1. Yes
    2. No
61. Name*
62. Email Address*
64. Address*
66. City*
67. State*
68. Zip Code*
70. Phone Number*

    Please format with dashes as above

72. 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?

    1. Yes
    2. No
74. Name*
75. Email Address*
77. Address*
79. City*
80. State*
81. Zip Code*
83. Phone Number*

    Please format with dashes as above

87. 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).

89. Certification Type

    Check all that apply

    1. Minority-Owned Business
    2. Women-Owned Business
    3. Veteran-Owned Business

    1. Substantial Physical Disability
    2. Economically Disadvantaged Area
    3. Other
91. Explain Other*

    If you marked "Other" certification type, please provide a brief explanation and upload proof in the upload section below.

93. Last Certification Date

    Please list last certification date for any of the certifications you checked.

95. Upload Certificate
96. Upload Certificate

    Use if you have more than one

98. Questions?

    For questions regarding this form or the vendor payment process, contact Accounts Payable Specialist Shirleng Tan Geil at 952-826-0341 or stangeil@EdinaMN.gov.

100. 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.

     1. I have read and understand the public records notice.
Leave This Blank:


102. Submit

* indicates a required field