Vendor Set Up and Payment Form

Vendor Set Up and Payment Form
ATTENTION VENDOR! A PURCHASE ORDER IS REQUIRED FOR ALL INVOICE TO BE PAID

PLEASE INCLUDE THE PO NUMBER ON ALL SUBMITTED INVOICES.
What Type of Information are you submitting*

Banking Information for ACH/Wire PaymentVendor Insurance InformationW9 DocumentationIdentification
Company Name
Billing Contact Name*

First NameLast Name
Tax ID #
Phone Number*

Country CodeArea CodePhone Number
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Payment Terms

Net 10Net 15Net 21Net 30Upon Receipt (additional approval will be required)Other
WE DO NOT PAY VENDORS UPON RECEIPT UNLESS THE TRANSACTION IS PRE-APPROVED BY GENERAL MANAGER OF THE LOCATION AND ACCOUNTING DEPARTMENT HAS BEEN NOTIFIED PRIOR TO SERVICES ARE ORDERED OR PROVIDED

WE REQUIRE A MINIMUM OF 5 BUSINESS DAYS TO SEND PAYMENT
Banking Information for Electronic Payment
Bank/Financial Institution Name
Bank/Financial Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Phone
Please enter a valid phone number.
Account Type

CheckingSavings
Bank 9 Digit Routing #
Account #
Vendor Liability Insurance Information
Liability Insurance Company Name
Phone Number
Please enter a valid phone number.
Insured Individuals Name

First NameLast Name
Policy Number
Expiration
W9 Form

And

Certificate of Insurance submission for Service Providers is required
Upload your files here

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Vendor Set Up and Payment Form

ATTENTION VENDOR! A PURCHASE ORDER IS REQUIRED FOR ALL INVOICE TO BE PAID

Banking Information for Electronic Payment

Vendor Liability Insurance Information

W9 Form

And

Certificate of Insurance submission for Service Providers is required