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PRIVACY ACT STATEMENT : The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information
collected on this form is required under the provisions of 31 U.S.C. 3322 and 31CFR 208 and 210. This information is used by Peace Corps
and the U.S. Treasury Department to transmit payment data, by electronic means to a vendor's financial institution. Failure to provide the
requested information may delay or prevent the receipt of payments through the Electronic Funds Transfer (EFT) Program.
REQUESTER INFORMATION
Last Name:
First:
MI:
E-mail:
Office Name:
Phone No.: (
VENDOR INFORMATION
Reason for Request (Please check one box):
New
Update
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Vendor Type: Select...
Vendor Name:
MI:
First:
Job Title/Position:
Birthdate:
Gender:
Phone No.: (
E-mail Address:
Address:
City:
State:
Zip Code:
Country:
State:
Zip Code:
Country:
Type of Account:
Checking
Savings
Lockbox
Yes
Small
Business
Completed
By:
No
Vendor No:
10/2011
PC 708 (formerly PC-CFO-FS 709) (10/2010)
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Requestor Information
The staff person preparing the form enters their last name, first name, middle initial, e-mail, office name, and phone
number.
Vendor Information
10/2011
PC 708 (formerly PC-CFO-FS 709) (10/2010)
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Print Form
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