Authorization Form to Receive Online Payments

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Email *

IF YOU ARE WANTING TO ADD A NEW BANK ACCOUNT OR CHANGE YOUR CURRENT BANK ACCOUNT INFORMATION THAT WE HAVE ON FILE - EMAIL accounting@develop-models.com

*

I UNDERSTAND THAT IF I AM ADDING A NEW ACCOUNT/CHANGING MY ACCOUNT INFORMATION THAT I HAVE TO EMAIL accounting@develop-models.com TO ENACT THE CHANGE

I hereby authorize Development, LLC dba Develop Model Management to deposit my payments to the bank account listed below. I acknowledge that transactions initiated to the bank accounts must comply with the provisions of U.S. law. This authorization will remain in effect until I notify Develop Model Management to cancel. *

I authorize and accept these terms and conditions.

Required

Model/Talent Name (First and Last Name) *

Date *

YYYY

Name on Bank Account *

Street Address *

City, State, Zip Code *

Telephone Number *

Bank Name *

City/State of Bank *

Example of information needed. Check number not required.

Type of Account (check one) *

Personal Checking

Personal Savings

Business Checking

Business Savings

Required

Bank Routing Number *

Account Number *

Re-enter Account Number *

Signature (Type Full Name) *

Date of Signature

YYYY

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