Fill - Free fillable Vendor & Supplier Update Form PDF form

Vendor & Supplier Update Form

General Information Update ☐ Banking Update ☐

Welcome to PRO!

We are pleased to welcome you and/or continue our business with you. As part of our vendor and supplier

management process please fill out this form. It is critical to PRO that we have the most accurate organization and

individual name, contact information and banking information if you choose to enroll in our ACH payment service.

Please contact PRO and fill out an update form and attached any required supporting documentation, should any of

your information change at any time. Note that a representative from PRO will contact to verify all information in this

form as part of our dual verification process. This will ensure you payments are paid timely to the appropriate recipient.

For changes to a TID/SSN or legal entity, please contact CS/Contracts, as this will require a new contract.

For guidance when completing this form, please see attachment 1. No handwritten forms will be accepted

*** PLEASE TYPE INTO THIS FORM ONLY ***

Part 1 – General Information

Supplier/Vendor Name:

Doing Business As (D/B/A), if applicable:

Contact Name:

Contact Phone #:

Contact Mailing Address:

Tax ID #/Last Four SSN:

Contact e-mail:

Website:

Assignment of payments, if applicable:

Are these payments being assigned, factored and/or paid to another party (if yes, see below)?

NO ☒ YES ☐

Name assignee for Payment . N/A ☐

Instructions:

If Payments are being sent to an entity other than the contracting entity, the Supplier will be required to complete a

formal Notice of Assignment (NOA). Please contact contracts@prounlimited.com for specific instructions and to obtain

the required NOA for execution (Note: No assignment of payment will be processed until; PRO has received a compliant

NOA)

✔

UPDATED 11-01-17

below a

nd: 1) elect ACH (Automated Clearing House) payments; and 2) ensure your contact information above is

correct.

I authorize PRO Unlimited, Inc. to deposit payments directly into the bank account named below. I understand and

voluntarily elect to participate in this payment option. I understand this election applies to all payments issued by PRO

Unlimited, Inc., regardless of end client. I acknowledge that by selecting ACH as the payment option, I also agree to the

possible extension of our contractual payment terms with PRO Unlimited, Inc. by up to two (2) additional business days,

but not to exceed seven (7) business days. I understand I can opt out of the program at any time, with thirty (30) days

written notice. This authorization will remain in effect until I notify PRO Unlimited, Inc., in writing, that I wish to

discontinue this service or until PRO Unlimited, Inc. has notified me that it has terminated the direct deposit service. In

the event your company has signed multiple ACH Remittance Authorization Forms, then the version with the most

current date will apply and supersede all prior existing ACH Remittance Authorization forms.

Please check the box below:

☐I choose to enroll in the Direct Deposit Service (Note: Direct Deposit remittance occurs two days after release of paper

checks. Example: If paper checks are released on Day 5, Direct Deposit occurs on Day 7.)

Please deposit the payments into the following bank:

Bank Name:

Bank Account Name:

Account Number: Checking ☐ Savings ☐

ABA/Routing Number:

Please attach a voided check or letter from your bank (Need help? See attachment 1):

Digital signature below only

Supplier Signature:_______

____________________________________ Date:_________________________

Title: _______________________________________________________

Please scan and return the PDF form & ALL support to: ACHSetUp@prounlimited.com

-----------------------------------------------FOR INTERNAL USE ONLY (reviewer must initial signifying the approval)-----------------------------------------------

CAS – Name/initials of analyst performing verification:

CAS – Banking support complete & acceptable: ☐

CAS – Form complete: ☐

CAS – Date all information dual verified :

CAS – W-9 complete & included: ☐

CAS – Name of contact for Vendor confirmation:

CAS – DBA/letter of assignment documentation included: ☐

CAS – Number dialed for Vendor confirmation:

AP – All required information received & approved: ☐

AP – Date system updated:

AP – Updated by: AP – Update review Manager:

Reviewers Initials:

Part 2 – Banking Information

PRO Unlimited, Inc. is pleased to offer our electronic remittance program to our Vendors and Suppliers. If you are

interested in receiving payment remittance from PRO electronically to your bank account, please complete the section

✔

click to sign

signature

click to edit

UPDATED 11-01-17

We at PRO are pleased to welcome you and/or continue our business with you. Below are instructions and tips to assist

you in completing the required Vendor & Supplier Initiation or Update Form to ensure a smooth and timely initial set-up

or change to your account.

Change Type (if an update form)

Simply check the appropriate box for the reason this form is being submitted:

• General information update

• Banking update

Part 1 – General Identification Information

• Supplier/Vendor Name: the name of the organization or individual that will be paid

• Doing Business As (D/B/A): if the name of the organization is not the same as the name on the bank account,

domain, website, etc. this must be provided with legal proof of the connection.

• Contact Name: the individual’s name or a contact at the organization that we can reach out to during the initial

set-up process, for future changes or should an issue arise at any time.

• Contact Phone #: the phone number (including any country code if foreign) of the individual listed above.

• Contact Mailing Address: the physical address of the organization or individual listed above.

• Tax ID or Last Four SSN: Tax ID for organization or SSN for individual, this should be consistent with the

information on the Form W-9 that is submitted.

• Contact e-mail: the e-mail address of the individual listed above.

• Website: the organizations website, if you have the vendor or supplier has one

• Assignment of payments – If your payments are going to a party other than yourself, you must complete this

section and provide the name of the assignee and a letter (see below)

General Supporting Documentation

o A Form W-9 form must be submitted with each initial request AND change/update. This form must be

typed and submitted as a .pdf file.

o When an organization changes their name, under the same Tax ID the following must be submitted:

1. Legal documentation from the Secretary of State noting name change; AND

2. Certificate of Amendment of Articles of Incorporation (if applicable)

o DBA - In instances where a company is “Doing Business As” a different name, legal documentation

stating the name of both entities will be required. This will likely include the DBA registration form and a

receipt for proof of payment for the registration fee, but will vary by local government.

o Assignment – a signed letter from you or your organization authorizing the stated party to receive fund

on your behalf. This letter should include all necessary banking information.

Attachment 1

UPDATED 11-01-17

these funds. Following are the required Acceptable forms of support, you must submit at least one of

he following (a or b):

a) A scanned copy of a voided check, saved as a .pdf file only. Photos of checks (.jpg files) will not be

accepted. This must be a valid check that it clearly states:

i. the organization or individual’s name

ii. the ABA/routing number of the bank

iii. the complete bank account number

b) A signed letter from the bank, which must include the following:

i. bank’s letterhead

ii. organization or individual’s name/name on the bank account

iii. the ABA/routing number

iv. the bank account number

v. signature of a representative from the bank

Signature

Only a digital signature will be accepted.

How to Configure a Digital Signature

a) Select the digital signature field

i. Dialog box will ask

to configure digital Id(if not already configured)

ii. Select the configure button

iii. Choose where to save your digital id and create an account

iv. Once configured you will now be able to apply your Digital Signature

part 2 – Banking Information

• Bank Name: the name of the banking institution

• Bank Account Name: the name on the actual bank account (organization, person, DBA, Assignee, etc.)

• Account Number: the bank account number, which can be verified on the required support (see below for

Required & Acceptable Bank Account Supporting Documentation)

• Account Type: Simply check the box for checking or savings

• ABA/Routing Number: the banking institutions unique routing number, which can be verified on the required

support (see below for Required & Acceptable Bank Account Supporting Documentation)

Required & Acceptable Bank Account Supporting Documentation

The security of our Vendor and Supplier payments and their banking information is of the utmost

importance to PRO. Our goal is to protect all funds paid and ensure the correct party is in receipt of

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