WELCOME to the IPROMOTEU Vendor Electronic Payment Authorization Form.

By completing and submitting this form, I am acknowledging acceptance of the terms for payments from iPROMOTEu on behalf of it's affiliates. *

I will accept payments via ACH within 45 business days of invoice date.
I will accept payments via Credit Card within 10 business days of invoice date. (iPROMOTEu will not accept credit card fees for any credit card transaction)

Bank Name *

Bank Address *

Address Line 1

Address Line 2

City

State

Zip Code

Routing Number: *

Account Number *

Company Name (Name On Account): *

Address On Account *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

ACH Remittance Email Address: *

Email

Confirm Email

Authorization: By selecting this checkbox, I hereby authorize iPROMOTEu to deposit funds into our account for the payment of goods and services.

Name *

Title: *

Contact Phone: *

Date / Time

Signature *

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iPROMOTEu Vendor Electronic Payment Authorization