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Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

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  • Agency Information
    • About Us
    • Commissioners
    • Director's Office
    • Legislation
      • Arizona Statutes
      • Arizona Rules
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      • All Public Meetings
      • Commission Meeting Agendas
      • Meeting Minutes
  • Divisions
    • Administration
      • Accounting
      • Human Resources, Special Services and MIS
      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
      • Boiler Section
      • Elevator Section
      • Occupational Safety and Health (OSHA / ADOSH)
      • Research & Statistics (BLS)
    • Claims Division
    • Labor Department
    • Legal Division
    • Medical Resource Office (MRO)
    • Special Fund Division
  • News and Events
    • Public Notices
    • News and Events
  • Resources For
    • Resources for Employees
    • Resources for Employers
    • Resources for Insurers
    • Resources for Medical Providers
    • Resources for ICA Community
  • How Do I
  • Online Services
    • Forms
    • Self Service Center
    • ICA Community
  • Payment Portal
  • OMBUDSMAN
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  • State of Arizona Substitute W-9 and ACH Vendor Authorization Forms & Instructions

State of Arizona Substitute W-9 and ACH Vendor Authorization Forms & Instructions

Instructions

This form is required in order to establish or update a vendor account with the State of Arizona. A vendor that provides goods or services to an Arizona state agency and receives payment from the State of Arizona must complete this form. Once completed, mail the form to:

DEPARTMENT OF ADMINISTRATION/GENERAL ACCOUNTING
OFFICE ATTN: VENDOR SETUP
100 N 15TH AVE, STE 302
PHOENIX, AZ 85007

 

Sign and Submit Form

GAO State of Arizona Substitute W-9 & Vendor Authorization Form

Related Forms

Insurance Carrier - Quarterly Tax Form
Insurance Carrier - Annual Tax Form 200
Self-Insured Employer - Quarterly Tax Form
Self-Insured Employer - Annual Payroll Report Form
Self-Insured Employer - Annual Medical Report Form
Self-Insured Employer - Annual Injury Report Form
Self-Insured Employer - Annual Hospital Report Form
Workers’ Compensation Liability Form
Self-Provider of Medical Benefits Form
Initial Application for Authority to Self-Insure
Notice of Self-Insurer’s Termination of Self-Insurance Form
Initial Pool Application for Authority to Self-Insure
Reversal Form for Reversing Automated Payment Processing
State of Arizona Substitute W-9 and ACH Vendor Authorization Forms & Instructions

Official Website of the State of Arizona

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Contact Us:

Phoenix Office
800 W. Washington Street
Phoenix AZ 85007
602-542-4661

 

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Contact Us:

Tucson Office
2675 E. Broadway Blvd
Tucson AZ 85716
520-628-5188

 

 

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