Vendor legal Name

First Name

Last Name

contact name

First Name

Last Name

company address

city

state/province

zip/postal code

country

Mobile Number

Email adress

Type of Goods or Services

Federal Tax ID#/SSN/VAT:

Bank Name

Bank Address

Beneficiary Name

First Name

Last Name

Beneficiary Address

IBAN Number

Account Number

Swift/Routing/ABA

(if any)

Account Currency

Beneficiary E-mail

I certify that the information provided on this form is correct, and I hereby authorize Plastik inc to electronically wire payments to the bank account designated above. I understand that I must notify Plastik inc in writing immediately of any changes in status or banking information.

Authorized Individual's Printed Name

Title

Signature

Date

YYYY

** For US Individuals and Entities please fill the W9 form ** For non US Individuels please fill the W8-Ben form ** For non US Entities please fill the W8-Ben-E