Bank Details Form

Your Full Name*
First Last
Email*
Beneficiary Full Name*
The person's name in which the account is held.
Beneficiary Address on File with the Bank*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Beneficiary Account Number*
Your account number, or IBAN for European banks.
Bank Name*
Bank SWIFT/BIC or BSB or Routing Number*
SWIFT/BIC is a bank branch identifier applicable everywhere in the world (except North America) . BSB numbers are for Australian & NZ banks. Routing Number is for North American banks.
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Comments or Notes:
Bank Account Details
Accepted file types: jpg, gif, png, pdf, doc, docx.
If you have a screenshot, or document with your bank account details, then you can upload here if you wish.