Contractor Information Form (Agreement for Services)

RETURN TO THE SCHOOL DISTRICT OF PHILADELPHIA:
CONTACT PERSON _______________________________ FAX # _________________
Contractor Information Form (Agreement for Services)
CONTRACTOR - Please fill out this form with information requested below and fax it back to your contact at
the School District (at the fax number written above). Please complete and return this form as soon as you can,
in order to help the School District expedite your contract.
1.
Legal name of entity: ___________________________________________
If you don’t know this information, please ask someone in your organization who does know, such as
your General Counsel or Chief Financial Officer.
2.
State where this entity was formed and legal type of entity:
__________________________________________________________________
Write the state where the entity was legally formed and the entity’s legal type (e.g., a not-for-profit
corporation). Again, see someone in your organization who knows this information if you don’t.
Correct examples include:
i Pennsylvania not-for-profit corporation ‰ Delaware corporation
i New Jersey limited liability company ‰ New York limited partnership
(Not: “a 501(c)(3)”, or “a C corporation”)
3.
Street address (we will not accept P.O. Boxes) where your organization’s office is located (if the
organization operates out of a residence, insert that address):
_____________________________________
_____________________________________
_____________________________________
4.
Your federal employer identification (or social security) number: _________________.
5.
Name, and telephone number of contact person (also include contact person’s mailing address if
different from the address of the organization’s office):
_____________________________________
_____________________________________
_____________________________________
_____________________________________
6.
Name and title of person in your organization authorized to sign and legally bind the contractor to the
contract (e.g., executive director, president, vice president, partner):
______________________________________
Name
______________________________________
Title