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New Vendor Application

Please complete the below information.

Section 1 – Vendor Identification

Legal Business Name(Required)

DBA/ Trade Name

Vendor Type(Required)

Manufacturer

Distributor

Contractor

Service

Section 2 – Contact Information

Primary Contact

Email

Phone

Quality Contact

Email

Phone

Section 3 – Addresses

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Remit to Address the same as above(Required)

Section 4 – Payment Information

Payment Terms

N30

N45

N60

Other

Payment Method

ACH

Check

Wire

Remittance Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank Name

Account Number

Routing Number

SWIFT

Account Type

Checking

Savings

Section 5 – Tax & Legal

Please select the document(s) that will be attached:

W-9

NDA Signed

** If either document is missing, this could delay Vendor set-up**

File

Drop files here or

Max. file size: 50 MB.

Section 6 – Authorization

Consent

I certify that the information provided is accurate and authorize payments per the details above.

Name

First Last

Title

Date(Required)

YYYY slash MM slash DD

Δ

We create aquatic mechanical products that use less and give more. Products that promote healthy communities, inspiration, and reduce their negative impact on the environment.

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