GP Business Partner Updates

Do you or have you billed ICBC via MSP-Teleplan?
	Yes No *

Contact MSP-Teleplan to make account updates

Does your clinic offer any of the below services?	Yes No *
Acupuncturists Chiropractors Counsellors Kinesiologists Occupational therapists Physiotherapists Psychologists

Review the vendor number page for vendor updates and applications.

Have you previously provided service to ICBC and know your account?
	Yes No *

Do you need to make any updates to the following? * (one or more must be chosen)
	Vendor Information Address Tax Information General Information Payment Method

Vendor Information

May start with a letter Existing Account Number

*

Legal Name

*

Legal Name 2
The operating name of a company, as opposed to the legal name DBA Name

Address
Address		*
City		*
Postal Code		*
Country
PO Box

Tax Information
GST Number		*

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 for reply to this submission

*