EDI/EFT ENROLLMENT FORM AP9088(08-01)



US ACH/EFT Enrollment Form

THIS FORM MUST BE ACCOMPANIED WITH A COPY OF A CHECK OR ROUTING INFORMATION PROVIDED ON BANK LETTERHEAD

|Type of Request: | New ACH/EFT set up Modify/Change of banking information Delete/Remove bank information |

|Type of modification: Co.Name Address Contact Name Email Fax Number Tel. Number Tax ID # |

|Remittance Communication Details Banking Info. |

|VENDOR INFORMATION |

|Company Legal Name:       |

|Company Doing Business As (if other than Legal Name):       |

|Vendor: Head office Branch CP Vendor No.: _ _ _ _ _ _ _ CP Contact Name:       |

|* Your7 digit vendor no. can be found on your CP check stub OR on bottom left hand corner of your Remittance Details |

|CONTACT INFORMATION |

|Company Address |Payment Remittance Address (where a check would be mailed) |

|Street Address:       |Street Address:       |

|P.O. Box # /Station # (if applicable):       |P.O. Box # /Station # (if applicable):       |

|City, Province/State:       |City, Province/State:       |

|Country, Postal Code/Zip Code:       |Country, Postal Code/Zip Code:       |

|Sales Account Manager’s Name:       |Accounts Receivable Manager’s Name:       |

|Phone Number:       |Phone Number:       |

|E-Mail Address:       |E-Mail Address:       |

|Fax Number:       |Fax Number:       |

|AUTHORIZATION DETIALS |

|      |      |

|AR Manager or Controller’s Name (printed) |Title |

|      |      |

|Signature of AR Manager or Controller |Date |

|TAX IDENTIFICATION NUMBER |

|(Please provideW9/ W8 if applicable) – this section MUST be completed: |

|Type of business: Corporation Partnership Fiduciary Individual/Self-Employed |

|Reg’d proprietor (unincorporated) Other:       Federal Business Number/Social Insurance Number: _____________________ |

| |

|GST REG. Number: |

|  |

|BC PST REG. Number: |

|PST-____________________ |

| |

|QST REG. Number*: |

|TQ |

|SK PST REG. Number: |

| |

| |

|MB PST REG. Number: |

|  |

|US FED TAX ID Number**: |

|  |

| |

|Note: *The QST registration number should have 15 characters: 9 digits, followed by the letter TQ and 4 more digits. |

|** Required if US address |

|Invoice Currency: USD (W9 and/or W8 required if applicable) CAD Other (please specify)       |

| |

| |

| |

|REMITTANCE COMMUNICATION DETAIL OPTIONS |

|Please choose one of the following options: |

|Option A - EFT - electronic funds transfer (EFT) payment with remittance detail via fax #: (____) _ _ _ - _ _ _ _ |

|Option B - EFT - electronic funds transfer (EFT) payment with remittance detail via E-Mail: |

|_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (ie: Accountsreceivable@) |

|BANK INFORMATION |

|Please select which bank document is included with this application *document MUST be included: |

|Bank document (Mandatory): Void Check OR Letter from Financial Institution on bank letterhead |

|Provide Sample Invoice (Mandatory): Sample Invoice Included |

|Vendors are responsible for notifying Canadian Pacific Railway of any changes to banking information. |

Please return the completed form along with a void cheque via email to:

US_APVendorMaintenance@cpr.ca and AP_EFT@cpr.ca

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