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Bank Account Info for Affiliate Payouts via ACH

ACH is our current method of payout for affiliates. As such, we need the following information in order to add you as a payment recipient in our bank account. The information you provide here will be temporarily stored in a password protected PDF until you have been added as a payee in my own bank account. No record of this data is stored on this site. Should you prefer to not provide this information, we will send any payouts to your affiliate email via PayPal. Note that payouts via PayPal may be delayed.

Affiliate Name
Address(Required)
Authorization(Required)
This field is for validation purposes and should be left unchanged.