(Company Letterhead of Vendor)

Banking Information for Payments

Company Information:

Company Name:

Remit to Address:

Banking Details

Name of Bank:

Bank Address:

Bank/Branch code:

Bank Account Number:

Beneficiary Name (as it appears on bank account)

SWIFT code:

Intermediary Bank Details (if applicable)

Information that should accompany each payment (if applicable):

N.A.

Payment Notification - I would like to receive notification by:

Email Address: or Fax Number:

Information provided by:

Name:
Contact by: E-mail:
Telephone:
Fax:

(Signed and company stamped)