Fillable Form Instructions: To become an approved H&R Block (H&Rblock)

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Form Instructions: To become an approved H&R Block (H&Rblock)

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NEW SUPPLIER REQUEST FORM / CHANGE FORM
New Supplier
Updated Information
Vendor # __________________
H&R Block (or its subsidiary companies) can make payments to you or your company via credit card (preferred method), electronic funds transfers (EFT)
or paper checks. Credit Card and EFT payments will receive a payment advice emailed to you or your company when each payment is made. Until the
setup process is complete for Credit Card or EFT payments you will continue to receive payments in paper check form.
Form Instructions: To become an approved H&R Block supplier you must complete all three sections of the form below and
sign for authorization. Send completed form to ACCOUNTSPAYABLEVENDORS@HRBLOCK.COM
SECTION ONE - Supplier Classification and Contact Information
SECTION TWO - Agreement to H&R Block's Payment Term Policies
SECTION THREE - Agreement to H&R Block's Invoice Submission Policies
SECTION ONE – SUPPLIER CLASSIFICATION AND CONTACT INFORMATION
Name as Displayed on Invoices:
(Please provide sample invoice)
Tax ID:
(Please provide copy of W9)
REMITTANCE INFORMATION
Remit Address:
City:
State: Zip:
Accounts Receivable\Billing Email Address:
(Required for emailed remittance advice)
CONTACT INFORMATION
Telephone:
Website:
1099 Email Address:
(Required to receive 1099 Misc by email)
Purchase Order Dispatch Email Address:
(Required to receive PO)
SECTION TWO – PAYMENT METHOD & TERM SELECTION
OPTION 1 – VISA CREDIT CARD (H&R BLOCK’S PREFERRED PAYMENT METHOD
Yes, please contact me to be paid via Virtual Credit Card at NET15
(Will receive a one-time use credit card number by email from US Bank)
Payment Terms:
NET15
For more information please visit:
https://www.usbpayment.com/payables-solutions/electronic/virtual-payments-supplier
or call 1 (855) 268-5386
OPTION 2 – ELECTRONIC FUNDS TRANSFER (BANK ACCOUNT INFORMATION)
Yes, I agree to be paid EFT at NET45
Payment Terms:
NET45
Bank ABA Transit Number: (Must be 9 digits)
Bank Account Number:
Bank Name:
Name on Account: (As shown on bank records)
OPTION 3 – PAPER CHECK
Yes, I agree to be paid via Check at NET60
Payment Terms:
NET60
Click to Lock Banking
Information
CONTRACTUAL TERMS
If you have a signed contractual agreement that states agreed upon payment terms please provide a copy of the contract with the submission of
this form and the terms will be honored. Please also select the above payment method.
Yes, I have contractual payment terms that have been agreed upon
Payment Terms:
**INVOICES UNDER $500 SHOULD BE PAID ON H&R BLOCK REQUESTER’S CORPORATE CARD. NEW VENDOR FORM NOT NEEDED**
SECTION THREE – COUPA SUPPLIER PORTAL (CSP)
The CSP is a completely free network with no contracts required to join. To connect to the CSP, an invitation needs to be emailed to the primary Coupa
account holder and accepted.
Email for CSP Invitation:
How Invoices Should be provided to H&R Block
• Non Purchase Order invoices must be submitted via the CSP.*
Required: Please ensure the H&R Block associate’s name or email that the invoice should be routed to for approval is
populated in the REQUESTER fields.
• Purchase Order invoices must be submitted in one of three ways below:
1. The PO must be flipped utilizing the Supplier Actionable Email you received with your PO email.
2. POs may be flipped into invoices by logging into your CSP account
3. A cXML direct connection between your ERP and Coupa can be setup to facilitate high
volume transactions
How to Check Invoice & Payment Status with H&R Block
All status inquiries should be done through the CSP (https://supplier.coupahost.com/)
*If due to system limitations you are unable to join the CSP, you may email your non-PO invoices to APInvoices@HRBlock.com.
Required: The invoice must be in a non-editable format (preferably PDF or TIFF) and must include the H&R Block associate’s
name that the invoice should be routed to for approval. Failure to do so will result in your invoice being rejected.
Email H&R Block will receive invoices from:
The undersigned authorizes H&R Block, or its subsidiaries, to make either credit card or electronic funds transfer (EFT) payments, as well as any necessary
adjustments involving these deposits, in the account defined and authoriz
es the institution defined to accept these deposits and make any necessary
adjustments. This authorization will remain in effect until written notice of termination is delivered to H&R Block. The undersigned agrees to be paid and to
submit invoices according to H&R Block's Payment Terms Policy and Invoice Submission Guidelines as previously noted in this document. Failure to comply
may result in delays in payment at which H&R Block will not be liable for any late penalties.
Name & title of person completing
this form (please print):
Authorization Signature: Date:
AUTHORIZATION
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Form Instructions: To become an approved H&R Block (H&Rblock)

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Completed 19 October 2021

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