Photography
VIDEO
DESIGN
MAGAZINE
Shop
ELI REZKALLAH
Photography
VIDEO
DESIGN
MAGAZINE
Shop
ELI REZKALLAH
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
MM
DD
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
Thank you!