Vendor Banking Template

Vendor Banking Template

Vendor Information

Individual / Sole Proprietor Corporation LLC Partnership Other

Payment Method and Currency

Select preferred payment methods and provide complete bank details for each selected method. Vendor acknowledges that incomplete or inaccurate data may delay payment.

ACH / Electronic Funds Transfer Wire Transfer Check Other

Bank Details — Domestic (ACH) / Primary Account

International Wire / SWIFT Details (if applicable)

Required Documentation

Attach or deliver the following documents with this submission. Failure to provide required documentation may delay processing and payment.

Voided check (for checking accounts) Bank letter on bank letterhead confirming account details Signed bank authorization / verification form Other (specify in Additional Notes)

Certification and Authorization

By signing below, Vendor certifies under penalty of perjury that the information provided on this form is true, complete, and accurate, and that Vendor is authorized to provide the bank account information supplied. Vendor authorizes the payor to initiate credit and, where applicable, debit entries to the account indicated above for payment of invoices and to correct erroneous payments.

Vendor agrees to notify the payor in writing of any changes to account information at least thirty (30) calendar days prior to a scheduled payment. The payor shall not be liable for loss, late payment, or other costs resulting from Vendor's failure to provide accurate or timely banking information. Vendor indemnifies and holds harmless the payor for any claims arising from payments made in good faith to the bank account or beneficiary designated on this form.

Vendor acknowledges that the payor may require verification of the banking information and that processing of the first payment may be delayed pending verification. This authorization remains in effect until revoked in writing by an authorized representative of Vendor and received by the payor at the address listed in the remittance section.

Terms, Fees and Governing Law

Payment terms are governed by the underlying purchase order, contract, or invoice between the parties. Unless otherwise agreed in writing, the payor's payment processing window may be up to 30 calendar days from invoice approval. Returned or rejected transactions due to incorrect banking information may be subject to administrative fees and reprocessing delays chargeable to Vendor.

This form and any disputes arising from it shall be governed by the laws of the state specified in the parties' contract. If no contract exists, the laws of the state in which the payor is organized will apply.

Effective Date and Change History

Effective Date:

Additional Instructions / Internal Use

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