Vendor Account Request

SECTION A – VENDOR TYPE INFORMATION

Type of Vendor

Type of Purchase

Referred by our sales person?

Yes

Sales Person Name

SECTION B – VENDOR ADDRESS INFORMATION

Vendor Information

Business Name

Business Website/URL

Business Primary Phone

Business Physical Address

Address 1

Address 2

City

State

Zip Code

Business Postal Address

Address 1

Address 2

City

State

Zip Code

Business Primary Owner Information

First Name

Last Name

Phone

SECTION C – VENDOR TAX INFORMATION

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

Employer identification number (EIN)

Taxpayer Federal

SECTION E – PAYMENT INFORMATION

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

Financial Institution Name

Financial Institution Address

Account Number (Including any leading zeros)

Country

United States

Canada

Ouside North America

US Only: Routing Number

Canada Only: Institution ID & Transit Number

Vendors Outside North America: SWIFT/IBAN

For ACH/Wire: I hearby authorize Wholesale Electric Caribe Inc., collectively referred to herein as “Company” or “WEC” to initiate a direct deposit creditentries and to initiate, if necessary, correcting debit entries for any credit entries made in error to the account number listed above. I also authorize the financial institution named above to credit and debit the same entries to the account. This Authority is to remain in full force and effect until the Company has received written notification from the vendor on this termination in such time and such manner as to afford the Company a reasonable time to act on it. Termination of vendor status shall automatically void this authorization.

Check | Letter

Maximum file size: 16.78MB

Do you have a merchant registration

Yes

Registro Comerciante

Merchant Registration Certificate

Merchant Registration Certificate Number

Merchant Registration Certificate

Maximum file size: 8MB

Registro de comerciante

Select Applicable Withholding for Services Rendered:

10% (Percentage applicable by Default)

Total Waiver

Partial Waiver

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

Certificate of good standing

Maximum file size: 16.78MB

Comments:

By signing this document, I certify that I am an authorized company representative and the information on this form is correct.

Signature

Clear

Printed Name

Date

If you are human, leave this field blank.

Vendor Information

Business Physical Address

Business Postal Address

Business Primary Owner Information

Accounts Receivable

ACH Direct Deposit

Merchant Registration Certificate

Certificate of good standing

By signing this document, I certify that I am an authorized company representative and the information on this form is correct.

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