Payee/Supplier Registration Form

Payee/Supplier Registration Form

If you're a retailer, supplier or payee expecting to receive money from the Ministry of Social Development that relates to a client, please complete this form.
An individualOn behalf of a business
What is your business’ name?*
What is the trading name of your business?*
What is your full name?*

First NameLast Name
YesNo
If yes, what is the GST number?*
If no, what is your IRD number?*
NoYes
NoYes
Please tick which applies for your accommodation:*
NoYes
FoodFuelCar repairsFurnitureClothingDental TreatmentMedical treatmentOptometryOther
NoYes
EFTPOS New Zealand or VerifonePaymark or ETSL
What is your Merchant ID Number?*
What bank account would you want your payments to be paid into?
The account is in the name of:*

The account number is:*

Rows	Bank	Branch	Account number	Suffix
Bank Account Number

What bank account would you want your payments to be paid into?