Copy of Vendor Details Form Last Version
1
VENDOR DETAILS FORM This form must be completed for all new suppliers prior to the supply of good or services. Section 1: Vendor details Company name: Jeeya International Address: 51/B Ground Floor, Ramarwadi, Sion (West) Mumbai-400017. Postcode: 400017 City-Mumbai Mumbai Mailing address- 51/B Ground Floor, Ramarwadi, Sion (West) Mumbai-400017. Postcode: 400017 City: Mumbai State: Maharashtra Country:India India Phone number: 9892162777 Fax number: Contact person name: Pranav Modi Position: E-mail: Phone number: 022-65730113,022- 28766789 Internet webpage Tax ID number: 27420727314V Tax ID type: Section 2: Bank details Please select your preferred method of payment Account number: ### Account holder: Jeeya International Currency INR Bank name: The Cosmos Co-Op Bank Ltd IBAN INR Swift Code INR Routing code: COSB0000012 Bank address: 36/A Maru Niketan DL Vaidya Road Dadar (West) Mumbai-400028 Postcode: 400028 City: Mumbai State:Maharashtra Maharashtra Country: India If you chose "check" please provide us the following details. Reason for selecting the check option: Ch Delivery Address: 51/B Ground Floor, Ramarwadi, Sion (West) Mumbai-400017. Contact person: Pranav J. Modi City: Mumbai State: Maharashtra Postcode: 400017 Section 3: Vendor acceptance Signature Position Name of signatory (please print) Date 13-15-2015 Section 4: Altisource Internal use only Vendor code: Please indicate the reason for this application: Received by Date Please indicate the status of W9 form Set up by Date Vendor Geography: Legal Entity: Vendor Group: Segment: Vendor Currency: INR Business Unit: Depart Number: [email protected] www.deepforgbag.com ACH Payment (Recommended) Check Vendor accepts that all the information provided is correct and true. applicatio n Update application W9 received W9 already on files
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Transcript of Copy of Vendor Details Form Last Version
VENDOR DETAILS FORMThis form must be completed for all new suppliers prior to the supply of good or services.
Section 1: Vendor detailsCompany name: Jeeya International
Address: 51/B Ground Floor, Ramarwadi, Sion (West) Mumbai-400017.
Postcode: 400017
City-Mumbai Mumbai
Mailing address- 51/B Ground Floor, Ramarwadi, Sion (West) Mumbai-400017.
Postcode: 400017
City: Mumbai
State: Maharashtra Country:India India
Phone number: 9892162777 Fax number:
Contact person name: Pranav Modi Position:
E-mail: Phone number: 022-65730113,022- 28766789
Internet webpage
Tax ID number: 27420727314V Tax ID type:
Section 2: Bank detailsPlease select your preferred method of payment
Account number: ###
Account holder: Jeeya International Currency INR
Bank name: The Cosmos Co-Op Bank Ltd
IBAN INR
Swift Code INR
Routing code: COSB0000012
Bank address:
36/A Maru Niketan DL Vaidya Road Dadar (West) Mumbai-400028
Postcode: 400028
City: Mumbai
State:Maharashtra Maharashtra Country: India
If you chose "check" please provide us the following details.
Reason for selecting the check option:
Ch Delivery Address:51/B Ground Floor, Ramarwadi, Sion (West) Mumbai-400017.
Contact person: Pranav J. Modi
City: Mumbai State: Maharashtra Postcode: 400017
Section 3: Vendor acceptance
Signature Position
Name of signatory (please print) Date 13-15-2015
Section 4: Altisource Internal use onlyVendor code:
Please indicate the reason for this application: Received by
Date
Please indicate the status of W9 form Set up by
Date
Vendor Geography: Legal Entity:
Vendor Group: Segment:
Vendor Currency: INR Business Unit:
Depart Number:
ACH Payment (Recommended) Check
Vendor accepts that all the information provided is correct and true.
New application
Update application
W9 received
W9 already on files
