Vendor Authorization Form - ACH/EFT Setup

 

 

 

Please complete this form for existing customer changes.

Financial Institution Information - Enter Your Banking Information
Request Type:
* Your Company Name:
* Bank Name:
* Account Type:
* Bank ABA Routing #:  For Canadian Routing/EFT Transit # Format: XXXXX-0YYY (XXXXX is Branch #, YYY is Institution #)
* Account Number:  * Currency:  
* Name on Account:
* Street Address:
* City/State/Zip/Country:
Verification Information - Existing Vendors

Existing vendors: For verification, we are requesting at least 2 fields completed (Vendor Number & PO or Invoice Number).
Don't know your Vendor Number? You can find it with a simple query by clicking HERE.

* Vendor Number:
PO Number:
Invoice Number:
New Electronic Remittance Information
* Remittance Email Address:
* Accounts Receivable Contact:
* Phone No:
Certification/Signature - all fields required

Authorization of Information
The vendor hereby authorizes Pattern Energy to initiate credit entries, (and if necessary debit entries), to the listed account above. This authority will remain in effect until Pattern Energy receives written notification from the vendor to terminate ACH transactions for the account listed above.

Changes in Account Information: Pattern Energy must receive written notification (30 days in advance) regarding changes to bank account information/ and or closures. If a change involves new bank information, a new ACH Vendor Authorization Form will need to be completed.

* Signature:
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