Alt Wire Form - USMP - US Mobile Phones

Alternate Wire Form

"*" indicates required fields

I,*

Will be issuing payment via wire/bank transfer On behalf of, Company Name:*

On Behalf Of, Buyer Name:*

This payment is for goods purchased on the below Sales Order Number(s) and I understand that is for goods being purchased and shipped to the company/person I am making the payment on behalf of. Sales Order Number(s):*

Relationship to Buyer (Please Select one, if Other, please explain):

Relationship*

Business Partner

Owner

Other

Please select one:

One-time Payment in the Amount of:

Making Payments on behalf of the above-mentioned company/person starting from (Date):

Wire Total:*

Date*

Supporting Documentation Required:

1. Government issued Photo identification
2. Wire Confirmation showing total wire amount, & business name

I understand all the information on this form, and I will provide US Mobile Phones Inc with all requested documentation. I understand that US Mobile Phones INC will do their research and due diligence and can contact me to verify any information listed on this form.

Please upload ID and wire confirmation here*

Drop files here or

Max. file size: 50 MB, Max. files: 5.

Email*

Phone*

Signature*

Date

Sales Rep:*