Biller Information

Biller Information

Operating Name*

As it appears on your invoice/bill

Company Legal Name:

If different from above

Address / Street / PO Box*

as it appears on your invoice/bill

City:*

Province:*

Postal Code:*

Main Phone Number:*

Business Website:

Business Number:*

First 9 digits of your GST registration number

WCB Number:*

Admin Contact Name:*

Contact for A/P

Admin Contact Title:

Admin Direct Phone Number:*

Admin Direct Email:*

Preferred Email for Payment Detail Reports Deliver*

Invoice numbers required?*

Select or enter value

Do you assign customer account numbers?*

Select or enter value

ATTACH A VOID CHEQUE OR EFT PAYMENT INSTRUCTIONS*

Drag and drop files here or

I authorize payments to be credited to the above*

Name of authorized officer*

Date:*

Send me a copy of my responses

Powered by

Privacy Notice|Report Abuse