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Hello Technical Gas Products, Inc.,

Everview Group LLC has partnered with CSI Paysystems to pay our Suppliers
electronically. In order to facilitate paying Technical Gas Products, Inc.
electronically we will need more information about you.

Below, you will be able to enter information about your business so that we
enroll you for electronic payments.

PLEASE VERIFY THE INFORMATION BELOW AND CORRECT ANYTHING THAT'S WRONG.

TELL US ABOUT YOUR BUSINESS

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* Required

Company Name *
Company name not correct? Please contact your buyer to correct it.
Company Legal Name is required.
Address *
Address is required.
Address 2
Address 2 is required.
City *
City is required.
State/Province * Choose One Alabama Alaska Alberta Arizona Arkansas British
Columbia California Colorado Connecticut Delaware District of Columbia Florida
Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine
Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana
Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York
Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova
Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island
Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas
Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon
State/Province is required.
Postal Code *
Postal Code is required.
Country * Choose One Åland Islands Afghanistan Albania Algeria American Samoa
Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba
Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium
Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet
Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina
Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African
Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia
Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote
D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican
Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia
Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana
French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana
Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea
Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican
City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic
Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan
Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic
of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao
Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives
Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico
Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro
Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands
Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue
Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian
Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn
Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda
Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint
Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia
Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon
Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain
Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland
Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United
Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia
Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab
Emirates United Kingdom United States United States Minor Outlying Islands
Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin
Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Country is required.
Web Site
Web Address required.
Primary Contact *
Primary Contact is required.
Primary Contact Title
Primary Contact Title is required.
Primary Contact Phone Number *
Primary Contact Phone Number is required.
DBA Name
DBA Name is required.
Tax ID

Tax ID Confirmation
Tax IDs do not match.
Business Description
Business Description is required.
Business Category * Choose One Apparel Banking Biotechnology Business Services
Chemicals Club Communications Construction Consulting Digital Education
Electronics Energy Energy & Utilities Engineering Entertainment Entertainment &
Leisure Environmental Finance Food & Beverage Gaming Gifts Government Health &
Beauty Healthcare Hospitality Insurance Machinery Maintenance Manufacturing
Media Not For Profit Other Outdoor Print Production/Non-Media Radio Recreation
Retail Security Shipping Technology Telecommunications Textiles Transportation
Travel TV Utilities
Business Category is required.

DOES YOUR COMPANY ACCEPT CARD PAYMENTS FOR INVOICES?
YES NO

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ARE YOU INTERESTED IN GETTING SET UP TO ACCEPT CARD PAYMENTS?
YES NO

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CREDIT CARD NETWORKS ACCEPTED:

MASTERCARD
VISA
OTHER

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DO YOU HAVE ANY TERMS OR FEES TO ACCEPTING CREDIT CARD?
YES NO

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You cannot accept virtual cards if you have terms or fees at this time.

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IF YOU'RE UNABLE TO ACCEPT CARD PAYMENTS, YOU MIGHT CONSIDER ACH PAYMENTS
INSTEAD.
ARE YOU INTERESTED IN GETTING SET UP TO ACCEPT ACH PAYMENTS?
YES NO

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We believe that our virtual card and ACH payment options offers the fastest and
most cost-effective ways to get you paid, but we're happy to send you a check if
that's what you prefer.

FEES

Fee (Flat)
Fee (Percent)
Fee (Tiered)
Fee (Other)
Fee (Cross-Border) Yes No

LIMITS

Limit Amount
Transaction Limits
Monthly Limit

TERMS

Tell us about any fees, terms, or discounts for card payments. Terms

TELL US ABOUT YOUR BANK

--------------------------------------------------------------------------------

* Required

Bank Name *
Bank Name is required.
SWIFT BICBank Routing Number *
Bank Routing Number is empty or invalid.
Account Type * Choose One Checking Savings
Account Type is required.
Bank Account Number *
Bank Account Number is required.
Bank Indicator * ABA
Bank Indicator is required.
Confirm Bank Account Number *
Confirmation for Bank Account Number is required.
Bank Account Numbers do not match.

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Vendor requests and authorizes Everview Group LLC (hereinafter referred to as
"Company") to initiate ACH credit entries to the account identified herein to
allow its customer(s) to remit payments.

This authorization shall remain in effect until Company has received written
notification from Vendor that this authorization has been terminated, with
sufficient time to allow Company to act on such instructions. The undersigned
represents and warrants that the person executing this authorization is an
authorized signatory on the commercial account referenced above and all
information regarding the account is true and correct. Vendor agrees that if any
ACH credits are returned Company nor Corporate Spending Innovations (CSI) shall
have any liability whatsoever and Vendor must resolve the issue directly with
its bank.

To revoke authorization, please contact and notify Company.

By submitting the above bank information, you acknowledge that you have read the
ACH authorization, representations and warranties set forth above and you agree
to indemnify Company and Corporate Spending Innovations (CSI) for any errors,
omissions or false statements provided herein.



I have the legal right to provide this bank information *
Legal right to provide this bank information is required.



CHECK MAILING ADDRESS

--------------------------------------------------------------------------------

* Required

Company Name *
Company Name is required.
Address *
Address is required.
Address 2
Address 2 is required.
City *
City is required.
State/Province * Choose One Alabama Alaska Alberta Arizona Arkansas British
Columbia California Colorado Connecticut Delaware District of Columbia Florida
Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine
Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana
Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York
Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova
Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island
Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas
Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon
State/Province is required.
Postal Code *
Postal Code is required.
Country * Choose One Åland Islands Afghanistan Albania Algeria American Samoa
Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba
Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium
Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet
Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina
Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African
Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia
Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote
D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican
Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia
Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana
French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana
Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea
Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican
City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic
Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan
Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic
of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao
Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives
Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico
Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro
Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands
Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue
Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian
Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn
Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda
Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint
Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia
Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon
Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain
Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland
Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United
Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia
Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab
Emirates United Kingdom United States United States Minor Outlying Islands
Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin
Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Country is required.

--------------------------------------------------------------------------------

Your Name *
Your Name is required.
Your Title *
Your Title is required.
Your Email *
Your Email is required.


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How would you like to receive payment remittances? * Choose One Call In Email
Fax Other Portal URL
Payment Method is required.
Email Address * (This is where we'll send your remittances.)
Valid Email Address is required.
Remittance Fax * (This is where we'll send your remittances.)
Remittance Fax is required.
Remittance URL * (This is where we'll send your remittances.)
Remittance URL is required.
Remittance Portal URL * (This is where we'll send your remittances.)
Remittance Portal URL is required.
Remittance Portal Username *
Remittance Portal Username is required.
Remittance Portal Password *
Remittance Portal Password is required.
Remittance Phone *
Remittance Phone is required.
Please explain your desired payment method: * (this is where we'll send your
payment)
Payment Method description is required.

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IF YOU CANNOT ACCEPT THE PAYMENT OPTIONS ABOVE, PLEASE CONTACT DAVID RUBINSTEIN
AT EVERVIEW GROUP LLC TO DISCUSS HOW YOU CAN BE PAID.

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Done

About CSI
×


ABOUT CSI

We selected CSI not only for the exceptional virtual card product they offer,
which is backed by both Visa and Mastercard, but also because of the wealth of
benefits their payment program brings to our vendors. CSI's 28 years of
experience will ensure that this transition occurs with minimal disruption to
your business. The process is simple, with a unique and secure virtual card
account number generated for each electronic remittance. This virtual card
payment is processed just as you would any other credit card payment.

To learn more about CSI, visit their web site at
https://www.corporatespending.com/.

If you'd like to talk to a CSI vendor enrollment specialist, call nnn-nnn-nnnn.

×


COMPANY AUTHORIZATION

Company requests and authorizes Corporate Spending Innovations® (herein after
referred to as "CSI") to initiate ACH credit entries to the account identified
herein to allow your customer(s) to remit payments.

This authorization shall remain in effect unless and until CSI has received
written notification from Company that this authorization has been terminated in
such time and manner to allow CSI to act on such instructions. Undersigned
represents and warrants to CSI that the person executing this authorization is
an authorized signatory on the account referenced above and all information
regarding the account is true and correct. Company agrees that if any ACH
credits are returned CSI shall have no liability whatsoever and the Company must
resolve the issue directly with its bank.

To rescind authorization, please contact your globalVCard Relationship Manager.

Download Accept
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