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UseĀ this form to facilitate request for payment fromĀ accounting.
Request For Royalty Disbursement
Your Email Address
*
Your Name (First & Last)
*
Company Name
Enter the exact name as it appears on your agreement. Individual or company. Complete name is needed.
Statement ID Number (can be located on any of your royalty statements)
*
Enter your "Statement ID Number" as it appears on your royalty statement in your dashboard.
Is your royalty generated $130.00 or more?
*
Yes
No
Is your payment information up to date?
*
Yes
No
Distributor Payment Information Update
1. Client Name: 2. Bank Name: 3. Bank Address: 4. Bank Sort / Branch Code: 5. Bank Swift Code: 6. Account IBAN: 7. Account Number: 8. Account Name:
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