UGryd Payment Form

UGryd Payment Form

For use with CBORD's UGryd Services
Welcome and thank you for choosing CBORD!

Before getting started, please note that you will need an authorized Customer contact to execute the form and provide banking information. In addition, the following information will also be required:

Quote Number
Tax ID Number
Void Check for upload

To assist with locating your Customer Name and CBORD Quote Number, please refer to the outlined sections below.

Once you are ready to begin, please click Next.

Customer Information
Customer Name*
CBORD Quote Number*
Customer Address*

Street Address

Street Address Line 2

CityState

Zip Code
Customer Phone Number*
Please enter a valid phone number.
Is your Department Address the same as your Customer Address?

YesNo
Customer Department Information
Department Name*
Department Address (if different from above)*

Street Address

Street Address Line 2

CityState

Zip Code
Department Phone Number*
Please enter a valid phone number.
Department Fax
Please enter a valid phone number.
Customer Contact Information
Customer Contact*

First NameLast Name
Contact Email Address*
Operational & Security Information
Customer Tax ID Number*

UGryd ACH Information
Customer should add CBORD as an approved vendor to their bank's debit blocker.
- Company Name: OFF-CAMPUS ADVAN
- ID: 1201231681
Bank Name*
Bank Branch*
Bank Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Routing Number/ABA Number*
Bank Account Number*
Voided Check*

Cancelof

Authorized Contact Name*

First NameLast Name
Authorized Contact Email*
A confirmation email will be sent to this address
Authorized Contact Signature*

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