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California State Vendor Data Record
(Required in lieu of IRS W-9 when doing
business with the state of California)
| PURPOSE: |
Information contained in
this form will be used by State agencies to prepare Information
Returns (Form 1099) and for withholding on payments to nonresident
vendors. |
| Business Name: |
The Very Last Word |
| Owners Full Name: |
Datica, Incorporated |
| Street Address: |
280 E. Hamilton Ave.,
Suite C |
| City, State and Zip: |
Campbell, CA 95008 |
| Are you subject to Federal
Backup Withholding: |
No |
| Vendor Type: |
Corporation |
| Federal Employer Identification
Number (FEIN): |
77-0428565 |
| Residency Status: |
Resident - qualified to
do business in CA/permanent place of business in CA |
| Vendor Activity: |
Equipment/Supplies (exempt
from state withholding) |
I hereby certify under penalty of perjury
that the information provided on this document is true and correct.
If my residency status should change, I will promptly inform
you.
| Authorized Representative: |
Robert D. Farrell |
| Title: |
President |
| Telephone: |
408-341-8800 |
| Date: |
June 15, 2000 |
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