Vendor Payment Authorization Form

Nexegon - Vendor Payment Authorization Form

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Vendor Payment Authorization (VPA) Form

All Publishers Are Required To Complete The Vendor Payment Authorization (VPA) Form To Submit Their Official Payment Details.

To Process This Form, Kindly Review Latest Email Received From admin@nexegon.com.

➤ U.S.-Registered Companies Must Submit A Completed W-9 Form.

Personal Information

First Name

Last Name

Registered Email

Phone Number

Invoice Details

Email (From Which Invoice Was Sent)

Invoice Name

Social Media Information

Facebook Profile URL

Teams Invite Link Or Username

Address Information

Address

Postal Code

City

State/Province

Country

Payment Details

Important: Please Ensure All Payment Details Are Entered Correctly, Especially The Deposit Address. We Will Not Be Responsible For Any Loss Due To Incorrect Payment Information.

Note: There Is A 5% Conversion Fee When Converting From USD To USDT From Bank To Binance.

Important: Please Select BSC (BNB Smart Chain) Network In Payment Method When Payment Is Through Binance.

Payment Method

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