Vendor (Including Prepaid Card Suppliers) Claim Form « Tidewater Marketing Global Consultants, Inc.

Enter Information

Name (Individual / Company)(required)
Contact Person (If Different)
Street Address(required)
Mailing Adress (If Different)
City(required)
State(required)
Zip Code + 4(required)
Taxpayer ID #(required)
Telephone #(required)
Cell Phone #
Facsimile #
Email(valid email required)
Name of each Person and Company with Whom You Dealt. Please include Address, Telephone #s and e-mail address.(required)
Amount Claimed(required)
Any amount claimed must be accompanied by a pdf file including a statement summarizing the transactions and invoices supporting each transaction. Provide pdf copies of an executed copy of any and all pertinent agreements.(required)
Other Information Deemed Pertinent