Garick NON-Transporation Vendor Packet Form

Garick Non-Transportation Vendor Packet form

8400 Sweet Valley Dr. Suite 408 Cleveland, OH 44125 1-800-242-7425 care@garick.com
CONTACT INFORMATION
IndividualSole ProprietorshipPartnershipCorporationLTDLLPLLC
Business OR Individual Name*
DBA
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accounts Receivable Address (if different from mailing address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accounts Receivable Contact Person

First NameLast Name
Office
Please enter a valid phone number.Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Email
example@example.com
Please describe the service your are providing*
CHOOSE YOUR PAYMENT PROGRAM
Quick Pay/Direct Deposit 10 Days, 5% discount, NET 60Quick Pay/Direct Deposit 15 Days, 3% discount, NET 60NET 60 - Direct Deposit
If selecting Direct Deposit, you must submit a voided check with this form.

If you do not select direct deposit, you will automatically be entered to receive a paper check NET 60.
Upload Copy of Voided Check

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TAX INFORMATION

Tax Identification - Please fill out the information below and UPLOAD a W-9 form

For security reasons, please do not enter your SSN or Federal Tax ID# on this website, please make sure they are properly listed on the W-9 form you submit.

NOTE: IF your TAX ID is associated with a W-9, you must submit a W-9 for either Indivudual or Company or your packet will not be processed, and will result in delay of payment.
Legal Name on W-9*
Upload W-9*

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Signature

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Name*

First NameLast Name
Title*
Please verify that you are human*
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Garick Non-Transportation Vendor Packet form