Domestic vendor creation / amendment form Clear Form
Please use this form to register Australian Domestic bank details with DFAT.
Please complete al
sections of this form. If a question does not apply to you, write N/A
If you have any questions about this form or you need help completing it, contact Financial Operations on 02 6261 1157
or email@example.com DFAT Agreement Manager to complete:
(Complete this section before sending form to the supplier)
Administered or Departmental funding?
DepartmentalDFAT Contact Name:
Create or amend vendor?
Old Account number (if amendment):
Section 1: Supplier details
Business or individual name
If you do not hold an ABN, please complete and provide the “Statement by supplier form”
Do you identify as a ‘smal business’ (please tick)?
Business contact person:
Section 2: Financial institution details
Do you accept payment via Credit Card?
If so, is there an additional charge and how much?
, in my capacity as
hereby authorise DFAT to
direct payments for goods and/or services to the fol owing account:
Bank name and branch
Please note, a signature is not required when
this form completed and emailed by the
supplier directly to firstname.lastname@example.org
Date/Signature of authorised representative