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:

Email

Contact Phone:

Date / Time

Signature

Clear Signature

iPROMOTEu Vendor Electronic Payment Authorization