Banking Information

banking Information

* Indicates required field

Company Name *

How would you like to be paid? *

US Check Yen Check ($5) Wire Transfer ($15)

US and YEn checks

Make Check Payable To: *

First

Last

Address To Send Check To: *

Line 1

Line 2

City

State

Zip Code

Country

Wire Transfer Information

Name on Account *

First

Last

Bank Name *

Account Number *

Location (City, State/Province/Country) *

Bank Address *

Line 1

Line 2

City

State

Zip Code

Country

SWIFT Code *

If your bank is located outside the United States, the following additional information is REQUIRED for a wire transfer:

U.S. Intermediary Bank *

U.S. Bank City, State *

ABA Number *

Routing Number *

Comment *

Submit