Direct Deposit Form
Today's Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Please include the date which this form is being submitted
Artist/Business Name
Name that appears on your bank account (if different from above)
*
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Your address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Name and Address
*
Please provide the current Bank Name and Address which you currently use for Direct Deposit
Routing Number
*
Account Number
*
Account Type
*
Checking / Savings Account
Signature of Endorser
*
Please sign for authorization to use direct deposit system to make direct payments into the above listed account.
Submit
Should be Empty: