University Business Receivables

Update Billing Preference

Account Type(Required)

Business / Organization

Individual / Person

EIN: (XX-XXXXXXX)

Business Partner Number:(Required)

Business Partner Name:

Do you wish to receive electronic invoices?

Yes

Enter the email address to receive the electronic invoice:

Business Mailing Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Contact Email:(Required)

Completed By:(Required)

First Last

Title:

Email:(Required)

Phone Number:(Required)

Please review all information for accuracy prior to submitting this form.

If you have questions, please contact ar@purdue.edu