Valpak Corporate: 1 Valpak Ave North, St Petersburg, FL 33716 Supplier Information Request Form
Please access the Vendor Change Request form to submit changes to your existing vendor request application.
GENERAL INFORMATION
BUSINESS STATUS INFORMATION
Please select the appropriate response below:
We are required by the IRS to keep IRS Form W-9 on file for all vendors. You can obtain a blank Form W-9 via the attached link: https://www.irs.gov/pub/irs-pdf/fw9.pdf
BANK INFORMATION FOR ACH PAYMENTS
REMITTANCE INFORMATION
AUTHORIZATION
I authorize V P Holdings or subsidiaries and the financial institution listed above to electronically deposit invoice payments into my bank account. If monies to which I am not entitled are deposited into my account by V P Holdings or subsidiaries, I authorize V P Holdings or subsidiaries to direct the bank to return said funds. This authorization will remain in effect until it has been cancelled in writing.
CREDIT CARD PAYMENTS
PRODUCTS OR SERVICES YOUR COMPANY PROVIDES
ADDITIONAL DATA
OPTIONAL
LIST 3 CREDIT REFERENCES
INFORMATION PROVIDED BY
Disclaimer: I agree that by typing my name and clicking submit, I am agreeing to and electronically signing this document and that it will be binding on me to the same extent it would be if signed by me in person.