Instructions:
APPLICATION FOR VENDOR DIRECT DEPOSIT PAYMENT
New Application Change of Information
Procurement Services
Date Stamp
1. All fields on this form are mandatory and must be completed by the vendor (please print) prior to submitting the form
2. Please attach a blank void cheque for all banking information provided below. If a void cheque is not available, please
attach a letter from your financial institution confirming the banking information.
3. Send the completed application to ProcureToPay@smu.ca
Procure to Pay Services, Saint Mary’s University, 923 Robie Street, Halifax, NS, B3H 3C3
OR Fax to 902-420-5180
VENDOR
INFORMATION
Vendor
Na
m
e
Contact
in
Accounts
Receivable
First
N
ame)
Contact’s
email
(
mandato
r
y
)
Contact
Phone
(include
area
code
and
ex
t
ension)
Vendor
Main
P
h
one
(if
different
t
han
Contact
Ph
o
ne)
Vendor
Remitt
a
nce
Address
Ci
t
y
Province/State
Postal
C
ode/Zip
Count
r
y
Email
Address for Notification of Deposit (
mandatory
)
BANKING
INFORMATION
Name
of
Financ
i
al
Institution
Account
Number
Chequing
Savings
Institution
No.
(3 digits)
Branch
Tr
a
nsit
Number
(
5
digits)
Branch
Address
Ci
t
y
Province
Postal
Code
The required banking information may be located on your bank statement, encoded deposit slip, cheque (see
sample below), bank account passbook or obtained by contacting your financial institution.
***** PLEASE ATTACH A CHEQUE MARKED “VOID” *****
AUTHORIZATION
I/we, the above named business, authorize Saint Mary’s University to credit my/our bank account indicated above. I/we will
notify Saint Mary’s University Procure to Pay Services promptly in writing if my/our banking information is changed. I/we are
authorizing signing officer(s) for the business. I/we have retained a signed copy of this authorization form.
________________________________________ ____________________________________________ ____________________________
Name of authorized signing officer(s) Signature(s) Date
For Financial
Services Use Only
Procurement Services Approval Date Vendor ID
Setup Processed Date Address Type
Setup Verified Date Address Seq.
Financial Services – Procure to Pay Services February 2017
click to sign
signature
click to edit
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