Electronic Funds Transfer Form | Kicker AMA Arenacross

Name *

First

Last

Email *

Phone *

Financial Institution Information

Name of Bank *

Bank Address

Address Line 1

Address Line 2

City

State

Zip Code

Nine-Digit Routing Transit Number: *

Account Name: *

Account Number *

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. *

I agree

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