CFG INC. ACH Form-_11.08.21

CFG Inc.
Electronic Transfer Payment Form
Date:
_________________
Country:
___________________________________
Vendor Company Name: _____________________________________________________________
Company Tax ID No: _____________________________________________________________
Vendor Company Address: _____________________________________________________________
Vendor Bank Name: _____________________________________________________________
Vendor Bank Address: _____________________________________________________________
Vendor Bank Account No: _____________________________________________________________
Vendor Bank Account Type: _____________________________________________________________
Does your bank accept ACH or Wire? Yes No
ABA Routing No. for ACH: _____________________________________________________________
ABA Routing No. for Wires: _____________________________________________________________
Swift Code:
_____________________________________________________________
If a Non‐US Based bank, please provide intermediary bank info:
Bank Name: _____________________________________________________________
ABA Routing No: _____________________________________________________________
SWIFT code: _____________________________________________________________
I hereby declare under oath that the natural person or legal representative of the company, duly
authorized, has provided in this form the correct and complete data and that it corresponds exclusively to
the information of the company and its bank account number within the bank.
Name (print name):
____________________________________________________________
Vendor Signature: ________________________ __________________________
Natural Person
Legal Representative
Contact Information: Email: ___________________________ Telephone. No.: ________________
Address: ________________________________________________________
Signer Government ID No:
Company Stamp:
____________________________________________________________