Elementor #9890

Dragonblade Publishing, Inc.

Direct Deposit

Authorization Form

Full Legal Name(Required)

Federal Tax ID#

Your Federal Tax ID Number is the number used on your IRS Form W-9.

Account Type(Required)

Bank Account Number(Required)

Bank Routing Number (ABA Number)(Required)

Bank Name(Required)

Consent(Required)

I agree to the following:

I hereby authorize Dragonblade Publishing, Inc. to send credit entries (and appropriate debit and adjustment entries), electronically or by any other commercially accepted method, to my account indicated on this document. This authorizes the financial institution holding the Account to post all such entries. I agree that the ACH transactions authorized herein shall comply with all applicable U.S. Laws. This authorization will be in effect until Dragonblade Publishing, Inc. receives a written termination notice from myself and has a reasonable opportunity to act on it.

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First Last

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Date(Required)

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