Corteva Enrollment Form

Status

Reason

Enroll Date

Win Date

Company*

First Name*

Last Name*

Title*

Email*

Street*

City*

State/Province Code*

Postal Code*

Phone*

Manager Name*

Manager Title*

Manager Email*

Payment Remittance Email*

Tax ID*

All payments from Corteva to your Company will be made via Virtual Credit Card, in USD. Virtual Credit Cards will be delivered via email, from incontrol@mastercard.com, and should be immediately processed. Each Virtual Credit Card is a single-use credit card, and may apply to multiple invoices. Please let the Citi agent know if you have any card processing limitations that could impact your ability to process these credit cards.

* Corteva will not agree to a surcharge or a fee for paying with a virtual credit card.

* Contact us at Corteva@info14.citi.com or call us at 877-345-6923. Our fax number is 855-859-6873.