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Vendor Request Form
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Vendor Information
Title
Company
*
<Choose a value>
Metro Ontario Inc
Metro Richelieu Inc
McMahon Distributeur pharmaceutique Inc
Groupe Adonis Inc
Vendor Number
*
(Type '000000' as vendor number if and only if you do not have your vendor number yet.)
Transaction Type
*
<Choose a value>
<Choose a value>
Vendor Name
*
Contact Name
*
Contact Email
*
Phone Number
*
Ext.
Fax Number
Request number of an old request
Detailed Information Required
Type of request
*
<Choose a value>
Payment amount is incorrect
Outstanding invoice
Need information on why a deduction was made
Status of Late Payment
Other Payment Inquiries
Deduction related to an agreement
Deduction - promotion - Ontario
Deduction - promotion - Quebec
Deduction - warehouse delivery - Ontario
Deduction - warehouse delivery - Quebec
Claim QFF/EPI
Invoice Number
*
Invoice Amount
*
Invoice Date
*
PO Number
Details of problem or request
(Details field is mandatory for "Payment amount is incorrect" or "Other payment inquires" request types)
Check Information or Electronic Payment Information
Check number or Electronic payment number
Reference number on check stub
(The reference number on check stub must be provided when a check number is entered)
Security code
*
Type the characters (case sensitive) displayed in the above picture.
Document
Please upload your documents again since they are no longer available due to a long period of inactivity.
The size of each individual file attached cannot exceed 4 MB.
There remains 5 document(s) to upload.
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