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) 

___________________                                             _____________________

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