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Checklist - U.S. Supplier Registration  
Multiple organizations must report information about TI suppliers regarding tax, environmental, business activity,
diversity, and ethics requirements. 

 

 
Your cooperation with providing this information is critical for TI to report
correct information to the appropriate agencies in the United States.
   
 

1.Obtain the Setup ID which is given in your email invitation from TI.  Texas Instruments registers suppliers on its database with its classification form and does not accept the 1099 or other tax documents as a substitute.

This form is used as a Substitute W-9. If a requester gives you a form other than Form W-9 to request your TIN,  you must use the requestor's form if it is substantially similar to the Form W-9.

Verify or obtain a D-U-N-S number from Dun & Bradstreet.
 
Complete the Registration form with the following information:
    
Setup ID provided in the invitation email from TI.  This is required for setup on the TI database.
Legal name (as report to the Internal Revenue Service) this is REQUIRED for correct reporting of 1099-MISC information.
Tax ID tax identification number in the United States
DBA name of the company that you are Doing Business As
DUNS #  - the number assigned by Dun & Bradstreet registration.
Physical Address which includes email
Remit (pay to) Address - address to which payments are to be sent.
Bank information for electronic payment requires completion of a separate EFT Form.
  To provide bank information for EFT payment, complete the EFT Form. Follow the instructions on the form to submit.
Email address to receive purchase order requirement for TI eProcurement strategy for receipt of orders.
Web Address (URL) - your company website.
Business Size, Type, Activity, Category
  LARGE, SMALL, AND SMALL DISADVANTAGED BUSINESS DEFINITIONS AND CERTIFICATIONS
 
LARGE BUSINESS CONCERN - A major corporation with more than 500 employees.    
SMALL BUSINESS CONCERN - By checking the appropriate box on the front of this form, the Vendor represents and certifies that it is a small business concern and all end items to be furnished will be manufactured or produced by a small business concern in the United States, its territories or possessions, Puerto Rico, or the Trust Territory  of the Pacific Islands.
SMALL DISADVANTAGED BUSINESS CONCERN - By checking the appropriate box on the front of this form, the Vendor represents and certifies that it is a small disadvantaged business concern.  The Vendor represents and certifies that the Small Business Administration (SBA) has or has not made a determination concerning the Vendor's status as a small disadvantaged business concern.  If the SBA has made such a determination the date of the determination was ___/___/___, and the Vendor certifies that it was found by the SBA to be socially and economically disadvantaged as a result of that determination and that no circumstances have changed to vary that determination, or it was not found by the SBA not to be socially and economically disadvantaged as a result of the determination, but circumstances which caused the determination have changed.
NOTIFICATION - The Vendor agrees to notify Texas Instruments, before award, of any change in its status as a small disadvantaged business concern, occurring between the submission of this certification and contract award.
PENALTY - The Vendor represents and certifies that the above information is true and understands that whoever for the purpose of securing a contract or subcontract under subsection (a) of section 1207 of Pub. L 99-661, misrepresents the status of any concern or person as a small business concern owned and controlled by a minority as described herein shall (i) be punished by imposition of a fine, imprisonment, or both; (ii) be subject to administrative remedies including suspension and disbarment; and (iii) be ineligible  for participation in programs conducted under the authority of the Small Business Act.
Business Classification for minority or women-owned business only. Requires reporting of certification agency, certificate number, and date of certificate expiration.
  WOMEN-OWNED BUSINESS DEFINITION by checking the appropriate boxes on the front of this form, the Vendor represents that it is a Women Owned Small business concern. "Women-Owned" as used in this provision, means a small business that is at least fifty-one percent (51%) owned by a woman (women), who is a (are) U.S. citizen(s) and who also operate and control the business.
Ethic group for qualifying ownership selections are defined on the form.
Company Division, Subsidiary, Country of Non-U.S. Supplier
Ancient Forest fiber
by checking the appropriate box on the front of this form, the Vendor certifies that a program to eliminate the use of ancient forest wood in derived products does not exist, has been started, or has been completed for all products supplied to or through the course of supplying services to Texas Instruments. 
Environmental, Safety, & Health
by checking the appropriate box on the front of this form, Vendor certifies compliance with, and ensures that its employees, contractors, subcontractors and agents comply with, and provide all notices and other communications required under, all applicable local, state, federal and international laws, ordinances, rules, governmental or judicial orders, regulations and guidelines, including but not limited to the Occupational  Safety and Health Act ("OSHA") and all environmental and public and employee health and safety laws (collectively "ESH Laws").  Additionally, the Vendor agrees to comply with the Federal Acquisition Regulations (FAR 52.223-1) regarding the clean air and water control acts.
Affirmative Action Representation Certification
AFFIRMATIVE ACTION REPRESENTATION/NON-SEGREGATED FACILITIES - by checking the appropriate box on the front of this form, the Vendor represents that it has or has not filed all required compliance reports required by FAR 52.222-26 and representations indicating submission of required compliance reports signed by proposed subcontractors, will be obtained before subcontract awards.
A. "Segregated facilities," as used in this provision, means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time checks, locker  rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees,  that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin because of habit, local custom, or otherwise.
B. By the submission of this form, the Vendor certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained.  The Vendor agrees that a breach of this certification is a violation of the Equal Opportunity clause in the contract.
C. The Vendor further agrees that (except where it has obtained identical certifications from proposed subcontractors for specific time periods) it will:
Obtain identical certifications from proposed subcontractors before the award of subcontracts under which the subcontractor will be subject to the Equal Opportunity clause;
Retain the certifications in the files; and
Forward the following notice to the proposed subcontractors (except if the proposed subcontractors have submitted identical certifications for specific time periods):
[NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON - SEGREGATED FACILITIES]
A Certification of Non - segregated Facilities must be submitted before the award of a subcontract under which the subcontractor will be subject to the Equal Opportunity clause.  The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e. quarterly, semiannual, or annually).  NOTE: The penalty for making false statements is prescribed in 18 U.S.C. 1001.
Quality systems certifications certification for quality systems such as ISO9000.
Ethics questions - does the supplier employ current or former TI employees as Owners, Officers, or Employees.
Name, Title, phone number of the person completing the registration form.
       
 
CERTIFICATION  & PENALTIES
 
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding., or  (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
Failure to furnish TIN  If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding  If you make a false statement with no reasonable basis that results in no backup withholding, you are subject  to a $500 penalty.
Criminal penalty for falsifying Information  Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs  If the requester discloses or uses TINs in violation of Federal law, the requester may be subject to civil and criminal penalties.