Vendor Number Updates
* required
Have you previously provided service to ICBC and know your account?
Yes
No
*
May start with a letter
Account Number
*
Regarding your ICBC vendor account, what information do you need to update?
*
(You may select more than one)
Vendor Information
Address
Tax Information
General Information
Payment Method
Services Provided
Vendor Information
Legal Name
*
Legal Name 2
The operating name of a company, as opposed to the legal name
Operating Name
Address
Address
*
City
*
Postal Code
*
Country
*
PO Box
Tax Information
GST Number
*
Are you billing as a clinic or as an individual health care provider?
*
Clinic - all services provided by all disciplines will be billed and paid under this number
Physician or Individual Health Care Provider - Services will be billed and paid directly to the Physician or Individual Health Care Provider
GST Number
Clinic Information
Legal Name
*
Legal Name 2
The operating name of a company, as opposed to the legal name
Operating name
GST Number
Does your company gross over $30,000K per Fiscal year?
Yes
No
*
Address
*
City
*
Postal Code
*
Country
*
PO Box
Phone Number
*
Email for reply to this submission
*
General Information
Does your company gross over $30,000K per Fiscal year?
Yes
No
*
Payment Method
How do you want to be paid?
*
Cheque - payment and statement sent via Canada Post
EFT - Payment and Statement sent electronically
Email address
(to receive a confirmation email)
*
Services Provided
1
Add
Remove
*
Add
Health Care Provider Type
-= Please select a Health Care Provider Type =-
Acupuncturist
Chiropractor
Clinical counsellor
Kinesiologist
Massage therapist
Occupational therapist
Physician
Physiotherapist
Psychologist
*
Health Care Provider First Name
Health Care Provider Last Name
Health Care Provider or Association Number
Add another Service
Email for reply to this submission
*