Form: Electronic Funds Transfer Details
*This information will be stored on a secure server with restricted access and accessed only to transfer payments*
INFORMATION ABOUT YOU
Full name
*
First Name
Last Name
INFORMATION ABOUT THE FINANCIAL INSTITUTION
Financial Institution Name (Bank, C. Union, etc.)
*
Bank, Credit Union, etc.
Direct deposit information (required)
Phone number
*
Please enter a valid phone number.
Email
example@example.com
Recipient Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Signature
Send
Should be Empty: