New Vendor Account Request

SECTION A – VENDOR TYPE INFORMATION

Type of Vendor
Type of Purchase
Referred by our sales person?

SECTION B – VENDOR ADDRESS INFORMATION

Vendor Information

Business Physical Address

Business Postal Address

Business Primary Owner Information

SECTION C – VENDOR TAX INFORMATION

W-9 Request for Taxpayer Identification Number and Certification (required if U.S. Citizen or U.S. Person):*

Taxpayer Federal

SECTION E – PAYMENT INFORMATION

Accounts Receivable

Please provide primary accounts receivable contact.
Currency
Payment term with this Vendor.
Accepted payment methods
Please indicate the methods you accept for payment.

ACH Direct Deposit

Please provide a voided blank check or a letter on company letterhead with a signature, printed name and a date or a letter from the financial institution with a physical signature, printed name and a date within the last 6 months. Any fields marked “See Attached” will be returned

Maximum file size: 16.78MB

Do you have a merchant registration
Registro Comerciante

Merchant Registration Certificate

Maximum file size: 8MB

Registro de comerciante
Select Applicable Withholding for Services Rendered:
In the Case of Total or Partial Waiver Indicate Expiration Date: (Attach copy of total or partial waiver, upon expiration 7% shall be withheld from payments in the manner required by the Puerto Rico Internal Revenue Code 2011, as amended, until a new waiver certificate is provided).

Certificate of good standing

or Certificate of Account Status

Maximum file size: 16.78MB