New Supplier Registration Form

New Supplier Registration Form
Supplier/Vendor Details:
Business Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number
Please enter a valid phone number.
Project Manager Name:

First NameLast Name
Project Manager Phone Number
Please enter a valid phone number.
Project Manager Email
example@example.com
Phone Number
E-mail
example@example.com
Accounts Receivable Contact name
Accounts Receivable email
Accounts Receivable Phone number
W-9 File Upload*

Please attach a current copy of your W-9.
Cancelof
ACH Authorization Agreement:

I hereby authorize Integrated Water Services, Inc. (IWS) to initiate automatic deposits to my account at the financial institution named below. I also authorize Integrated Water Services, Inc. to make withdrawals from this account in the event that a credit entry is made in error.

Further, I agree not to hold Integrated Water Services, Inc. responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until Integrated Water Services, Inc. receives a written notice of cancellation from me or my financial institution, or until I submit a new ACH form to the Accounts Payable Department (ap@integratedwaterservices.com).
Name of Financial Institution:  *
Name of Account Holder:   *
Routing number:   *
Account number:   *
Type a question

Checking AccountSavings Account
Signature*

Clear
Should be Empty:

New Supplier Registration Form

ACH Authorization Agreement: