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NC Office of the STATE OF NORTH CAROLINA <br /> . $iATE,;, <br /> State Controller <br /> SUBSTITUTE W= 9 FORM <br /> * Denotes a Required Field <br /> This form is to be genor Modification to Existing Vendor Records 4, n ,� •� <br /> "� •� <br /> completed by the vendor . <br /> This form is to be completed by the vendor if one or more of the following have changed : <br /> 1 . Change of remittance address . <br /> 2 . Change of Social Security Number ( SSN ) , or Employer Identification Number ( EIN ) , or Individual Taxpayer <br /> Identification Number ( ITIN ) . <br /> 3 . Change of Vendor Name . <br /> Please complete the applicable sections below . <br /> Section 1 : <br /> CHANGE FROM : Remittance Address CHANGE TO : Remittance Address <br /> * Address Line 1 : * Address Line 1 : <br /> Address Line 2 : Address Line 2 : <br /> * City * State * Zip (9 digit) * City * State * Zip (9 digit ) <br /> * County * County <br /> NOTE ; If you would like to receive your payments electronically, please <br /> complete the Vendor Electronic Payment Form <br /> Section 2 : <br /> CHANGE FROM : SSN , or EIN , or ITIN CHANGE TO : SSN, or EIN , or ITIN <br /> (PRESS THE TAB KEY To ENTER EACH NUMBER) ( PRESS THE TAB KEY To ENTER EACH (NUMBER) <br /> Section 3 : <br /> CHANGE FROM : Vendor Name CHANGE TO : Vendor Name <br /> * Legal Name : Legal Name : <br /> Business Name/ DBA/ Disregarded Entity Business Name/ DBA/ Disregarded Entity <br /> Name, if different from Legal Name : Name, if different from Legal Name : <br /> * Printed Name : * Printed Title : <br /> * Authorized U . S . * Date : <br /> Signature : <br />