NEW VENDOR SET UP TODAYS DATE * MM DD YYYY SECTION 1 - AUTHORIZING INFORMATION The person filling out this form who is authorized to share company information. First Name Last Name SECTION 2 - ADDRESS INFORMATION Legal Business Name * Include DBA (if applicable) Main Phone * Country (###) ### #### Contact Email * Physical Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing Address * Complete if Banking and Billing uses a different address Address 1 Address 2 City State/Province Zip/Postal Code Country SECTION 3 -BUSINESS ENTITY Tax Identification Number (EIN or SSN for Sole Proprietors) * Type of Business Entity (Corporation, LLC, Sole Proprietorship, Partnership, etc.) * SECTION 4 - BANKING AND PAYMENT INFORMATION Bank Name Bank Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Routing Number Thank you!
