QBME_Change Payment Method Sheet

Updated Payment Information
Legal Name of Organization*
DBA Name (if applicable):
EIN Number:*
e.g., 23
Current Mailing Address of Organization*

Street Address

Street Address Line 2

CityState

Zip Code
ACH or Bank TransferDebit, Credit, or Paypal
Bank Name*
Name(s) on Bank Account (business name if used)*
Account Number*
must be 9-12 numbers - no spaces
Routing Number*
must be 9 numbers - no spaces
Personal CheckingPersonal SavingsBusiness CheckingBusiness SavingsOther
Bank Phone Number
Format: (000) 000-0000.
Date*

MonthDayYear
Date
First Name* Last Name* Date*
(Please enter the Client Name or Client Representative in the fields above)
Signature*
Should be Empty:

Updated Payment Information