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NEXCOM EFT Payment Data Sheet

Terramar Sports Inc. provided their electronic payment data to receive funds via EFT from NEXCOM. They designated HSBC Bank as the receiving bank and provided their account and routing numbers. Marisa Serrao and Lynn Ignaczak were authorized to change the data sheet. Terramar Sports opted to receive remittance advice from NEXCOM via EDI using specified qualifiers and identifiers. The information was certified as current, accurate, and complete by an authorized representative of Terramar Sports.

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Linda Marcano
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480 views1 page

NEXCOM EFT Payment Data Sheet

Terramar Sports Inc. provided their electronic payment data to receive funds via EFT from NEXCOM. They designated HSBC Bank as the receiving bank and provided their account and routing numbers. Marisa Serrao and Lynn Ignaczak were authorized to change the data sheet. Terramar Sports opted to receive remittance advice from NEXCOM via EDI using specified qualifiers and identifiers. The information was certified as current, accurate, and complete by an authorized representative of Terramar Sports.

Uploaded by

Linda Marcano
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

ELECTRONIC PAYMENT DATA SHEET

For Receipt of EFT Payments from NEXCOM

Date _____3/23/11__________ Duns # 808-678-887___________

Your Company Name Terramar Sports Inc. _______________________________________________________

and Address _580 White Plains Road Suite, 660; Tarrytown, NY 10591____________________________

_________________________________________________________________________

Did you assign NEXCOM an internal company number? If yes please add here:_______________

PART A
Your Receiving Bank Name _HSBC Bank USA N.A. _______________________________________________

Your Receiving Bank Address _452 Fifth Ave; New York, NY 10018 _________________________________

__________________________________________________________________

Your Account Number _129023060______________________________________________________________

Your Receiving Bank's _0__ 2 _ 2 0_ 0 _ 0 0 _ 2 _ 0 ____


Routing Number (ABA#) or SWIFT code (if applicable)
ACH Format: CTX Checking X____ Saving ____

PART B Name Signature Phone #


Persons authorized
to change this Data Sheet Marisa Serrao_____ ______________________ 914-372-3216_____________

Lynn Ignaczak ____ ______________________ 914-372-3221________________

___________________ ______________________ _________________

PART C REMITTANCE ADVICE


Note: Some financial institutions will provide remittance advice (details) to you for an additional fee. If you are unable to re-
ceive remittance advice from your bank, you may select one of the following methods to receive this information from us:

__X___ EDI [V]: Qualifier 12 Sender/Receiver ID 9149348000 Van _____ IBM acct ______ User ID ______

_____ FAX [F] Fax number ________________ Contact name _______________________________________


_____ Email [E] Email address ____________________________ Contact phone # _______________________

NEXCOM 820 specifications can be found on our web site: [Link]


Qualifier: 08 Sender/Receiver ID: 9252671859 VAN: QRS IBM Global Acct: R0654 User ID: R0654ED

Registration Acknowledgment
I hereby acknowledge that the information provided is current, accurate and complete as of the date of this submission.

____________________________ _________________ __________


Print Name T elephone No. Date

__________________________
Signature

Fax this form to: ATTN: _________________ * Mailing Address: Navy Exchange Service Command
FAX (757) 631-___________* 3280 Virginia Beach Blvd.
Voice (757) 631-___________* Virginia Beach, VA 23452-5724
* K/M ASSOCIATE IS TO FILL IN NAME, FAX, & PH OF SENDER

ELECTRONIC PAYMENT DATA SHEET For Receipt of EFT Payments from NEXCOM Fax this form to: ATTN: _________________ *

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