Form #13168 has been rejected

Powered by

Coupa Software ( http://www.coupa.com )

TheKey, LLC

Form #13168 has been rejected

Hi Timothy,

Form #13168 has been rejected and updates have not been applied.

Form Response:
2. New Supplier External Response Form (V.3)

Requested by
Timothy Thomas

Response
Original

Supplier Information Request

Need assistance with navigating the Coupa Supplier Portal,
collaborating on this form with colleagues, or other Coupa
related questions? See the comprehensive "CSP Admin and User
Guide" below:

Coupa Supplier Portal Admin and User Guide:
CSP_Admin_and_User_Guide.pdf
( https://thekey.coupahost.com/attachment/attachment_file/type/183/CSP_Admin_and_User_Guide.pdf )

Supplier Name:
Lifeguard Health
Lifeguard Health

Doing Business As Name:
Lifeguard Health
None

Email for Purchase Orders to be Sent To:
rkelly@joinlifeguard.com
None

Primary Supplier Contact Information:

First Name:
Rosemary
Rosemary

Last Name:
Kelly
Kelly

Email address:
rkelly@joinlifeguard.com
rkelly@joinlifeguard.com

Work Phone:
+1 (949) 510-2832
None

Mobile Phone:
+1 (949) 510-2832
None

Fax:
None
None

Primary Supplier Address:

Address Purpose:
HQ
None

Region:
FL, United States, US-FL
None

Address Name:
Lifeguard Health Inc.
None

Street Address:
12762 SE Royal Troon Court
None

Street Address 2:
Ste 504
None

Street Address 3:
None
None

Street Address 4:
None
None

City:
Hobe Sound
None

Postal Code:
33455
None

Location Code:
SoFlo
None

Tax Information

Are you 1099 eligible?:
Yes
No

Organization Type:
Corporation
None

Tax Registration:

Country:
United States
None

Number:
******9288
None

Local:
No
No

W-8 or W-9:

Type:
W9

Attachments:
Form_W-9__Rev._March_2024_.pdf
( https://thekey.coupahost.com/attachment/attachment_file/type/510623/Form_W-9__Rev._March_2024_.pdf )

None

Remit To & Banking Info

Remit-To New/Banking Information:

CSP Remit-to ID:
4346156
None

Active or de-activate:
Active
Active

Payment Method:
Direct Debit

Are you an international or domestic supplier?:
Domestic

Remittance Address

Street Address:
2774 S Ocean Blvd
None

Street Address 2:
Ste 504
None

Region:
FL, United States, US-FL
None

City:
Palm Beach
None

Postal Code:
33480
None

Banking Information

Bank Account Number:
****629
None

Bank Routing Number:
******661
None

Bank Name:
BMO Harris Bank
None

Bank Address:
111 W Monroe St
None

Bank City:
Chicago
None

Bank Postal Code:
60603
None

Bank State or Region:
IL
None

Bank Country/Region:
United States
None

Bank Form:

Attachments:
Form_W-9__Rev._March_2024_.pdf
( https://thekey.coupahost.com/attachment/attachment_file/type/510631/Form_W-9__Rev._March_2024_.pdf )

None

TheKey Internal Use Only

*Set this field to "Email" for Purchase Orders:
prompt
prompt

*Set this field to "Email" for Purchase Orders:
None
None

Payment Terms:
None
None

Primary Subsidiary:
HCA Home Care Assistance Canada Inc.
HCA Home Care Assistance Canada Inc.

Primary Currency:
CAD
CAD

Vendor Category:
None
None

Supply Category:
Software
Software

Payment File Format:
None
None

Coupa Software ( https://www.coupa.com )

Total Spend Management - Make Margins Multiply

To change your notification preferences, go here and adjust your
settings ( https://thekey.coupahost.com/inbox/preferences )