Accounts Payable Vendor Application Form
Curtin Maritime, Corp.
Accounts Payable Vendor Application Form
Company Name:
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Terms Approved:
*
Available Curtin Account Credit Limit:
*
Remit to Name:
*
Remit to Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Remit to Overnight Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any specific information needed on check or ACH :
Accounting or A/R Contact:
*
First Name
Last Name
Accounting or A/R Email:
*
example@example.com
Accounting or A/R Telephone #:
*
Please enter a valid phone number.
Accounting or FAX #:
Please enter a valid phone number.
Account Rep Contact:
*
First Name
Last Name
Account Rep email:
*
example@example.com
Account Rep Telephone #:
*
Please enter a valid phone number.
Account Rep FAX #:
Please enter a valid phone number.
Federal Tax ID or SSN #:
*
Organization Type:
*
Website:
Curtin Maritime initiates ACH payment, please provide the information below:
Bank Name:
*
Bank Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Account Name:
*
Account Type:
*
Account #:
*
Routing #:
*
SWIFT Code (If international):
An IRS W-9 form must be attached with this form.
*
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Bank letterhead of banking information must be attached with this form. If one is not available, please attach a voided check, or document referencing banking information.
*
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Notes:
1. All invoices should be sent to ap@curtinmaritime.com 2. For any changes this form needs to be filled out again in order for us to update any information. 3. PO # are needed on all orders.
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