Fillable PAYEE INFORMATION ACH/DIRECT DEPOSIT ENROLLMENT AND AUTHORIZATION NEW

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PAYEE INFORMATION ACH/DIRECT DEPOSIT ENROLLMENT AND AUTHORIZATION NEW

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P a g e 1
1639 Route 10 East, 2
nd
Fl, Parsippany, NJ 07054 1 (800) 327-3553
S i m o n & S c h u s t e r
ACH/DIRECT DEPOSIT ENROLLMENT AND AUTHORIZATION
If you prefer to receive royalty advances and royalty payments
via ACH Electronic Funds Transfer/Direct Deposit, please
complete all fields below. Send this completed form along with
either A) a voided check or B) a confirmation letter from the
bank to Simon & Schuster by mail, email or fax.
The bank confirmation letter must be on bank letterhead and
must include: ACH ABA/Routing Number, Bank Name & Address,
your Account Name and Number, Bank Representative’s Name
and Contact Information
Mail to:
Simon & Schuster – Royalty Department
1639 Route 10 East, 2
nd
Fl
Parsippany, NJ 07054
Email:
royaltydept@simonandschuster.com
Fax #:
(973) 656-6070
NEW REQUEST *N CHANGE
PAYEE INFORMATION
Social Security Number or Federal Tax Identification Number
Contact Name
Name
Contact Telephone Number
Address
Contact Email Address
Contact Fax Number
City
State
Payee ID (if known)
BANKING INFORMATION
Bank Name
Bank Account Name/Credit To
Bank Address
Bank Account Number
Bank ABA/Routing Number
City
*State
Bank Swift Code
Remittance Email Address
By signing this form I hereby authorize Simon & Schuster to transmit electronic payments to the bank account at the financial institution
indicated above. I understand that any payments made by Simon & Schuster to me or to the author I represent may only be made to the bank
account listed above. Any change to the bank account or financial institution above requires that a new ACH/DIRECT DEPOSIT ENROLLMENT
AND AUTHORIZATION form be submitted. Failure to notify Simon & Schuster’s Royalty Department of any change to the above banking
information will delay payment.
Authorized Signature (owner, sole proprietor or company officer)
Date
Print Name
Telephone Number/Fax Number
Authorized Official’s Title (author, agent, owner, president, controller, etc)
Email Address
INTERNAL USE ONLY
Payee Number
Updated/Date
Approved/Date
Print Name/Signature
Print Name/Signature
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PAYEE INFORMATION ACHDIRECT DEPOSIT ENROLLMENT AND AUTHORIZATION NEW

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Completed 18 March 2021

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