Template: Payment Form for Winners

PAYMENT INFORMATION SHEET

The winner of <sponsor’s> crowdsourcing project must provide information required for us to issue a payment to award winners. All information is confidential and will only be used by <Sponsor> for its award payment process.

Competitor Information

Name of Winner: _____________________________________

Entry Name: _____________________________________

Address: _____________________________________

Telephone Number: _____________________________________

Email Address: _____________________________________

Payment Information

If your submission is chosen for an award, please select one of the following payment methods and provide the required information.

☐ Payment by wire transfer

• For US and Canadian winners: please provide your ACH transfer information (account number, routing number, name on account and account type - checking or savings).
• For international winners: Please provide your bank’s name and address, your name and address, your account or IBAN number and your bank’s SWIFT/BIC code.

Note - some additional information may be needed as well such as:

· Intermediary Bank Information

· FFC (for further credit) Information

· Reference Information

· Recipient/Bank Address

· Sort Code (UK)

___________________ _____________________

Signature Date