Direct Deposit Authorization
Provide your information to authorize direct deposit payments to your bank account.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Bank Name
*
Account Type
*
Checking
Savings
Bank Account Number
*
Routing Number
*
Please provide any special instructions or notes regarding your direct deposit (optional)
I hereby authorize Shipp Ranch, LLC (DBA: Tehachapi Mtn Barrel Racers) to deposit any amounts owed to me from event winnings, by initiating credit to my account at the below financial institution of my choice indicated on this form. If your bank information changes in the future, it is your responsibility to update your information on file.
*
Signature
*
Submit Authorization
Submit Authorization
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