E-Transfer Request Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Name
Account Number
Transit (Branch) Number
I authorize NuYugen Inc. to deposit my commission payments via e-Transfer using the information provided above. I understand that incorrect information may result in delayed payments.
I Authorize
Submit
Should be Empty: