SUPPLIER ENROLLMENT FORM - AFRICA Supplier Legal Entity Name: D&B Number:
VAT Registration Number:
(If applicable)
(If applicable)
Supplier Contact and Business Address: Name: Email Address:
Phone Number:
Address: Suburb/Town/City: Postal Code:
Country:
Supplier Bank and Account Information: Payments will be remitted to this bank account. All fields are required. Please contact your bank if you need help completing this section. Once payment is issued, a confirmation will be sent to the email address specified below. Branch code digit requirements: Nigeria - 9; Uganda - 6; Senegal - 4; Ghana - not required
Bank Name: Branch Code:
Branch Name: Address: Suburb/Town/City: Postal Code: Type of Account:
Country: Checking
Savings
Beneficiary Name: Email Address: Account Number:
Currency:
SWIFT/BIC Code:
(Senegal Only)
IBAN #:
Intermediary Bank: (Optional) Bank Name: Branch Name:
Branch Code:
Beneficiary Name: Account Number:
IBAN #: (Senegal Only)
SWIFT/BIC Code: Google Contact: Name:
Email Address:
@google.com
Payment Authorization I hereby authorize Google to initiate payments to the bank above and further warrant that I have the authority to authorize these transactions for the Supplier.
Name: Title: Signature:
Email Address: Date:
SAMPLE INVOICE
C A
B
Bill To: Google Ghana Limited 1st Floor, Physicians and Surgeons Building 54 Independence Avenue Ridge, Accra GHANA VAT No.: 124V038766
ABC COPORATION ADDRESS SUBURB/TOWN/CITY POSTAL CODE, COUNTRY FAX # VAT REGISTRATION #
Mail To: c/o Iron Mountain Accounts Payable - ACC N/O 147 Mlynske Nivy 73 Bratislava 821 05 Slovakia
Invoice Number
Invoice Date
1234567
D
Purchase Order Number
07.26.2010
12345
Description
Amount
Service/Goods Fee Service/Goods Fee
GHS 1.00 GHS 2.00
Service/Goods Fee
GHS 3.00
E
E VAT Rate (If Applicable): 10% TOTAL ABC CORPORATION Wire Banking Information: Acct #: Routing #: SWIFT/BIC Code: IBAN #:
GHS 0.10 GHS 6.10
F
LEGAL INVOICE REQUIREMENTS: A: Bill To Address: is located on the Purchase Order. This is the Google location purchasing the Goods and Services B: Mail To Address: this is the location to which invoices should be sent. Please send all invoices to c/o Iron Mountain, Acounts Payable - ACC N/O 147 Mlynske Nivy 73, Bratislava 82105 Slovakia C: Please ensure that your invoices have VAT reference number included D: Please ensure that invoices have a Purchase Order number specified. Obtain this from your Google contact E: If applicable, please ensure that both VAT rate AND amount is specified on your invoice F: Invoice should include a total of all goods and services and applicable VAT. Please ensure currency is specified Note: For timely payment, please ensure all required information is included; otherwise, we are unable to process the invoice and will need you to issue a new one.
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