AP Survey

Juice Vendor Intake Form

We can’t wait to work with you! Please take a moment to fill out the fields below to ensure we can submit timely payment and have the correct contacts to reach out to with any billing questions.

AP Survey

Legal Company Name(Required)

DBA (If Applicable)

Company Billing Address(Required)

Company Billing Address 1 Company Billing Address 2 Company Billing City Company Billing State Company Billing Zip Company Billing Country

AR Contact Name(Required)

AR Contact Email(Required)

AR Contact Phone Number(Required)

Please upload your W-9 (dated in the current year)(Required)

Max. file size: 50 MB.

Please upload your ACH or Wire Banking Information(Required)

Max. file size: 50 MB.

Bank Account Holder Name(Required)

Bank Account Holder Address(Required)

Your First & Last Name(Required)

First Last

Your Email Address(Required)

Signature(Required)