Employee Self-Evaluation

WIRE TRANSFER / ACH INSTRUCTIONS FORM

Please note that all information must be in English. Please complete the information requested below in its entirety. Contact your bank for any unknown information. If you have any questions, please contact [email protected] or ask for Sourcing at Phone number 1-321-784-7100 PAYEE/COMPANY INFORMATION SUPPLIERS FULL LEGAL NAME: TAXPAYER ID NO.

ADDRESS:

CONTACT PERSON:

TELEPHONE NO. FAX NO. EMAIL ADDRESS:

FINANCIAL INSTITUTION INFORMATION (Required) NAME OF SUPPLIER’S BANK:

ADDRESS:

SUPPLIER ACCOUNT NO

Swift Code / IBAN NO:

ABA / NINE DIGIT ROUTING TRANSIT NO:

DEPOSITOR ACCOUNT TITLE: TYPE OF ACCOUNT:

INTERMEDIARY BANK (CORRESPONDENT BANK) Non US Firms Only NAME OF BANK:

ADDRESS:

ACCOUNT NO

ABA / ROUTING TRANSIT NO

BANK ACCOUNT TYPE OF TITLE: ACCOUNT: Form #5060-012 Page 1 of 2 Effective Date: 4-JAN-2016 This material contains proprietary information of IAP Worldwide Services, Inc. (IAP). Disclosure to others, use, or copying without the express written authorization of IAP is strictly prohibited. Any authorized copying of this material, in whole or in part, must include this legend.

Ensure that the information is accurate and complete.

IAP will not be responsible for wires being transmitted with the incorrect Supplier information. This instruction sheet supersedes any instructions provided previously or on invoices. The only acceptable method of changing payment instructions is through this approved Wire Transfer / ACH instruction form; hence any changes made on invoices will not be accepted without the completed signed form.

Information below must match the information provided in box 6 on Supplier application form.

I have read and understand the above statements: (must contain two different Authorized signatures)

AUTHORIZED SIGNATURE TITLE

PRINT FULL LEGAL NAME DATE

AUTHORIZED SIGNATURE TITLE

PRINT FULL LEGAL NAME DATE

Internal IAP only Reviewed & Approved by: Signature Title and date Date entered into Printed Full name system