Vendor Information Form
Universities Space Research Association (USRA)

USRA Headquarters and President's Office
425 3rd Street SW, Suite 950
Washington DC 20024
Phone (410) 730-2656
Fax (410) 730-3496
[email protected]
To assist USRA in the compilation and maintenance of its bid/vendor source list, as well as the collection of data for reporting of its small business subcontracting activities, it is requested that the following information be provided. If you have any questions, please contact USRA Accounts Payable, (410) 730-2656. USRA MUST HAVE THIS INFORMATION TO PROCESS PAYMENT OF YOUR INVOICE.


Citizenship
Is Recipient:
  • :  
Select the country of which the recipient claims residency under that country's tax laws.
Current / Payment Address





Permanent Address









Federal Tax Class
  • : 
  • : 
USRA Employee?
Is this vendor a USRA employee?
     If you checked "Yes", skip Sections A and B.



T (Travel Agreement):
A. Consultant or Honorarium
B. Business Size
 (If a business, you must check one) For further clarification on business size, visit the Small Business Administration (SBA) website at http://www.sba.gov.
A concern that normally employs less than 500 persons, or as defined by section 3 of the Small Business Act, or is protected under another statutory category (please complete section B.1).
A concern which, including all divisions and affiliates, normally employs 500 or more persons, is independently or publicly owned or controlled and operated and which may be a division of another concern (foreign or domestic).
Foreign: A business concern located in a country other than the U.S. and its territories that is subject to the laws of that country. Other: A state or federal government agency.
B.1 Business Classification
 (check all that apply)
  • - 51% of business ownership must be owned by one or more socially and economically disadvantaged business individuals, as defined by the Small Business Act. For further clarification on business size, visit the Small Business Administration (SBA) website at http://www.sba.gov. (Please provide copy of certification)

  • Women Owned 51% of business ownership must be owned by one or more women - WOSB
  • (Please provide copy of certification)
  • (Applicable to section B.1 only)
THIS FORM IS REQUIRED TO PROCESS PAYMENT. PLEASE RETURN THIS FORM WITHIN THREE (3) BUSINESS DAYS TO THE ADDRESS ABOVE TO AVOID DELAY OF PAYMENT.