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Submitted URL: https://email.email.pandadoc.net/c/eJxMz7Fu2zAQxvGnETcZ5JGiqEFDWkNDXQRtkADOVByPR0e2RQoSYyN9-sJDGs_3P-D3hd5b7aMTIdP7xKn8GUP_rXvpnh...
Effective URL: https://app.pandadoc.com/document/v2?token=c0628aa4c12b22ddca1511e0aad86c53038ec728
Submission: On December 26 via manual from US — Scanned from US

Form analysis 1 forms found in the DOM

<form data-sentry-element="Form" data-sentry-component="NameInputCmp" data-sentry-source-file="index.tsx" class="form__Form-sc-4if0wz-0 lgwHGU"><span data-sentry-element="GhostSpan" data-sentry-source-file="index.tsx"
    class="ghost_span__GhostSpan-sc-173cwmz-0 dQBqXW">San Jose Water- Consolidated Form</span><input readonly="" class="input__Input-sc-1dlye1h-0 hEbRSF" value="San Jose Water- Consolidated Form" style="width: 323px;"></form>

Text Content

RevisionsCreated with Sketch.ImgReviewCreated with Sketch.

San Jose Water- Consolidated Form

BY MARIEL RULOMA

SA

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Please fill in 1 required field.
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SAN JOSE WATER- CONSOLIDATED FORM

1 of 1 document

Enterprise Storage & Servers Driven by Open Source

Please fill out the form according to the instructions, selecting only the
options that apply to you:
 * Domestic, US - Please accomplish Part I and Part II. a of this form, along
   with a signed W-9 form.
 * International, Non-US - Please accomplish Part I and Part II. b of this form.


Please write "N/A" if not applicable.


Customer Type:
Please select...
Domestic, USInternational, Non-US


I. Recipient Contact Information:
Legal Name
(If individual - First, Middle, Last Name)



DBA (if company)



Contact Number



Tax Address Information

Address Line 1



Address Line 2



City



State



Country (if Non-US)




II. Recipient Banking Information
a. Banking Information for US ACH Payments:
Bank Name



ABA (Routing)



Account Number



Name on Account



b. Banking Information for Other International Vendors:
Bank Name



Bank Address
(including city, state and country)



Remittance address
(if different from above)



Swift Code



IBAN Number



Account Number



Account on Name



Once we receive all the necessary information, we will process your payment
according to our earliest payment run schedule. Please feel free to contact us
at ap@ixsystems.com if you have any questions.





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