Electronic Fund Transfer Form

Name

Email

Phone

Name of Bank

Bank Address

Nine Digit Routing Number

Account Name

Account Number

By checking the box below you are acknowledging the above information and consent that this is also your 'electronic signature'.

I do hereby give permission to CYCLE CITY PROMOTIONS to electronically deposit funds into my bank account. I also agree that if I receive funds that were not intended for me, that I will return the money as soon as possible.

Submit