Request Royalty Payment

Use this form to facilitate request for payment from 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

Is your payment information up to date? *

Yes

Distributor Payment Information Update

GDPR Agreement *

I consent to storing my submitted information, in order to process my inquiry.

reCAPTCHA *

Last Name