EFT Form - CONNECT Music Licensing

We want you to get your money faster! We utilize Electronic Funds Transfer (EFT/Direct Deposit) as well as authorized Wire Transfers for International accounts, so your licence fees can be directly deposited into your bank account.

Member Information:

Member Name (name used during registration)*

Street Address*

City*

Country*

Province*

Postal Code*

State*

Zip Code*

Province/State/Territory*

Postal/Zip Code*

Title

Phone*

Fax

Email*

Bank Information:

Bank Name*

Street Address*

City*

Province*

Postal Code*

Name on Account*

Beneficiary Account #*

Bank # (3 Digits)*

Transit # (5 Digits)*

Authorization

I have the authority to sign this document and provide this information on behalf of the corporation

Signature

Title*

Full Name*

Date*

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