Vendor ACH/Wire Transfer Setup Form

 New ACH Setup Date: 07 /09/2023

 Updated ACH information
Vendor Information
Vendor Name AMIUYA GOLD ENTERPRISE
Cameron Vendor Number

Address NO 2 LOT 3032-B JLN SEROJA KG OLAK LEMPIT

City/State/Zip 42700 BANTING SELANGOR
Phone/Ext. 012-4778254 / 011-37778254
Fed Tax ID# or SS# or VAT#
Send Remittance Advice to amiuyagoldenenterprise@gmail.com
email address:
*Please provide a valid email address to receive remittance of the transfer

Bank Information
Vendor Name as on account AMIUYA GOLD ENTERPRISE
Bank Name AMBANK
Bank Address NO 6 & 7 JALAN S10/1 SECTION10, OFF JLN BUKIT 43000
KAJANG SELANGOR
Bank Account # 8881039391090
Bank Routing/ABA #
(9 digits)
If International:
SWIFT Code
IBAN #
Sort Code
Currency
ALL information must be completed to process ACH conversion. If preferred, the information above
can be returned on your company letterhead.
 We wish to continue receiving payments via check
I certify that I am an authorized representative of the above stated vendor.
Vendor Date 07 SEPTEMBER 2023
Signature

Name (Printed) NUR IZATIE AMIRA BINTI MOHD Phone 012-4778254

TARMIZI
Title OWNER AMIUYA GOLD ENTERPRISE Email amiraizatie@gmail.com

MDM-F-001, Rev 001, December 9, 2014