New Vendor Form – MineSense

Business Name: *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Website / URL *

Phone *

Sales contact *

First

Last

Sales contact email *

Accounts Receivable contact *

First

Last

Accounts Receivable email *

Purchase Order email *

Invoice currency *

Other currency

MineSense standard payment terms are Net 45 days

Standard Terms (45 days)
Other (Please specify below)

Other days - Justification required for any payment terms different than standard

Conflict of Interest

Have you or any of your company representatives had any personal or professional relationship with any MineSense employee?

Yes
No

If yes, please discuss with HR if conflict exists and see approval, by filling the section of the requestor.

Declaration

I hereby certify that the information provided above is accurate and up to date. I understand that any inaccuracies or omissions may delay the vendor setup process or result in termination of the vendor relationship.

Signature *

Clear Signature

VENDOR PAYMENT INFORMATION:

Beneficiary address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Beneficiary name:

Bank name:

Bank address:

Account number:

Bank code:

Transit number (5 digits):

SWIFT (for international):

IBAN (for European countries):

Tax identification number

Is the Vendor tax exempt

Please UPLOAD a void cheque for payment reference

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