Authorization Form to Receive Online Payments
Email address *
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. *
Required
Model/Talent Name (First and Last Name) *
Your answer
Date
MM
/
DD
/
YYYY
Name on Bank Account *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Telephone Number *
Your answer
Bank Name *
Your answer
City/State of Bank *
Your answer
Example of information needed. Check number not required.
Type of Account *
Required
Bank Routing Number *
Your answer
Account Number *
Your answer
Re-enter Account Number *
Your answer
Signature (Type Full Name) *
Your answer
Date of Signature
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service