Vendor Information Form

Please fill out ALL fields. Failure to do so will create delays in processing payment.

An example COI, our Credit Application, and our Sales Tax Exemption forms can be found at the end of this form in the “Vendor PDF Forms” button.

If you have questions, please contact Accounting at ap@passelfarms.com or 712-852-8520.

CONTACT INFORMATION

Business Name

Primary Contact Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

SSN/EIN

Payment Terms

Authorization Agreement For Automatic Cash Transfer

I hereby authorize you to initiate cash debit and credit entries and to initiate, if necessary, corrective entries and adjustments for any debit/credit entries in error to my checking/savings account indicated below and the bank named below, hereinafter referred to as BANK, to credit and/or debit the same to such account. This authority is to remain in full force and effect until OFI has received written notification from me of its termination in such manner as to afford OFI and BANK a reasonable opportunity to act on it.

Account Holder Name (as it appears on bank account)

Bank Name

Routing/Transit No

Account No.

Select One

Checking

Savings

Payment Remittance Email

File Uploads

Certification and Acknowledgement

Invoice Acknowledgement

Upon receipt of all required information and documents listed above we will immediately begin our review/approval process. All required information must be submitted before payment will be remitted. I agree to email all invoices to ap@passelfarms.com or mail to Passel Farms PO Box 96 Emmetsburg, IA 50536. I agree that all invoices will have a unique invoice number and should include a PO number.

I agree

Payment Acknowledgement

The date the invoice is received from the vendor will begin the terms to pay clock, not the date of the invoice. Payment terms shorter than 10 business days most likely will not be achieved. It takes time on our end to review, approve and process prior to paying an invoice. We will do everything we can to get your invoice paid as soon as possible but still must do our due diligence to ensure accuracy of our financials. Cash disbursements occur one time per week for all vendors and companies. If you are paid via ACH you can expect your payment to arrive in your bank account by Friday. Paper checks will be mailed on Fridays and delivered as soon as the USPS can get them delivered. Our goal is to issue payments to all vendors on time every time so long as we have been provided the required information and documents listed above AND the invoice(s) has been approved internally. Any delays in receiving all required information and documents OR discrepancies in the invoice amount will create delays in processing the payment.

I agree

Information Acknowledgement

I certify the information contained in this application is accurate, true and completed to the best of my knowledge and understanding. I authorize investigation of all statements contained herein and all information concerning this application and release all parties from all liability for any damage that may result from furnishing same to you.

I agree

Name

Printed Name acting as electronic signature

First Name

Last Name

Vendor PDF Forms

Vendor Information Form

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