Email: Vendor Setup Office Hours: Mon.-Fri. 8 a.m.- 4:30 p.m.
U.S.             Canada

Part 1: Identification of Beneficial Owner

Supplier Business Information

Nike Industry Code
-- Please Select --
Permanent Residence Address

Mailing Address
U.S. Tax Identification Number (if applicable, enter only one, not both)
Federal Tax ID             Social Security Number
Bank Account Information

Please attach required supporting documentation, which includes a listing of all banking information on company letterhead, vendor invoice, bank statement or voided check.

Part 2: Nike Contact Information and Relation to Nike

Yes             No
Yes             No
Yes             No
Yes             No
Yes             No
$0 - $100k             $100k - $250k             Over $250k

Part 4: Certification

Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct and complete.

Nike will accept the signature that appears below as legal and binding only if it is that of a principal or designated principal of the payee. Do not sign this form if you are not a principal or designated principal. This form must be signed by a principal or designated principal. Under penalties of perjury, I declare that (1) the information provided is true and complete; (2) I am not subject to backup withholding; and (3) I am not a U.S. person (or U.S. resident alien).

By typing your legal name and email address in the signature line below you are signing this form electronically and thus you are verifying and authenticating the statements in this submission.