Vendor Information

⚠ PO Box addresses are not allowed. Please provide a physical street address.

Address 1*

Address 2

City*

State*

ZIP Code*

✓ PO Box addresses are allowed for mailing address.

Same as Physical Address

I will upload the information

Bank Name*

Account Holder Name*

Routing Number*

Account Number*

Account Type

CheckingSavings

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Additional Notes (optional)

Tandem Services