A. General Information (Type of Request) ✘ A1. New Vendor A2. Activate/Modify Vendor A2.1 Current Vendor #: A3. Motives to modify a vendor: A3.1 Update Permanent Address A3.2 Add Bank Information A3.3 Update Company or Person Name A3.4 Add Pay Site B. Vendor / Supplier Information Vendor Type: Company Non Company B1. Company Name: B2. Contact Name: B3. Contact Title: B4. Contact Extension#: B5. Is your Company? a Small Business a Minority-Owned a Women-Owned N/A B6. Last Name 1: B7. Last Name 2: B8. First Name: B9. Middle Name: B10. Name as Shown in ID Doc.: B11. Phone Number: B12. Email: B13. Nationality: B14. Type of ID: C. Vendor / Supplier Permanent Address C1. Permanent Address: C2. City: C3. State/Province/Department/Other: C4. Country: C5. Postal Code (Required for US/Canada addresses): D. Banking Info – Required for Wires and Electronic Payments 1. Wire Payment: 2. Electronic Payment: N/A D1. Bank Name: D2. Bank Address: D3. Bank contact phone: D4. Branch Name: D5. Branch Number: D6. Account #: D7. Name on Account: D.A. Wire Payment Specific Information European Bank DA1. Routing / Swift code (BIC): DA2. IBAN#: An Intermediary Bank is needed?: YES NO DA3. Intermediary Bank Name: DA4. Intermediary Bank Account #: DA5. Intermediary Bank Routing / ABA#: D.B. Electronic Payment Specific Information DB2. Bank Routing / ABA#: N/A Checking Account: Saving Account: : E. Additional Pay Sites for payment purpose E1. Pay Site 1 info: E2. Pay Site 2 Info: