Prompt Pay Discount Form~1.doc

COMMONWEALTH OF MASSACHUSETTS

DPH Prompt Pay Discount Form

(Invoice discounts for receiving accelerated payments)

Vendor Name: .

Vendor Code (VCUST): .

Contract Number(s): .

Prompt Payment Discounts (PPD). All Vendors doing business with the Commonwealth must provide a Prompt Payment Discount (PPD) for receiving early payments unless the Vendor can define a statutory or legal reason for accelerating payments (MM3, M03 and M04 contracts). Vendors benefit from PPD by increased, usable cash flow as a result of fast and efficient payments for commodities or services rendered.

The Commonwealth benefits because Vendors reduce the cost of products and services through the applied discount. While Vendors have flexibility in determining the actual % discount(s) offered to the Commonwealth, the discount(s) must be identified for 10, 15, 20 and/or 30 days for payment issuance in the column entitled “Prompt Payment Discount %” below. The Department of Public Health may use the prompt pay discounts submitted as a basis for selection and may negotiate discounts as deemed in the best interest of the Department.

If a Vendor does not chose a Prompt Day Discount or if there is no statutory or legal exemption, the vendor will be paid within the 45 day payment cycle in accordance with the Commonwealth’s Bill Paying Policy.

All discounts offered will be taken in cases where the payment issue date is within the specified number of days listed below and in accordance with the Commonwealth’s Bill Paying Policy. Payment days will be measured:

from the date goods are received and accepted / performance was completed OR the date an invoice is received by the Commonwealth, (whichever is later) to the date the payment is issued as an EFT (preferred method) or mailed by the State Treasurer.

The date of payment “issue” is the date a payment is considered “paid” not the date a payment is “received” by a Vendor.

If internal Vendor systems require an alternate method of measuring payment issue dates, the Vendor must note the issues below or on an attached page if necessary to be considered by the PMT.

Enter the Prompt Payment Discount percentage (%) off the invoice payment, for each of the payment issue dates listed, if the payment is issued within the specified Payment Issue days. For example:

5% - 10 Days

4% - 15 Days

3% - 20 Days

2% - 30 Days

If no discount is offered enter 0% and check box below.

FORMCHECKBOX

I agree to the 45 day cycle. No Prompt Pay Discount is offered.

Vendor Authorized Signature _________________________________ Date: ____________

Vendor Authorized Signatory Print Name and Title: __________________________________