Fillable Royalty Payment Form

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Royalty Payment Form

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The Royalty Payment Form form is 1 page long and contains:

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  • 8 check-boxes
  • 18 other fields

Country of origin: OTHERS
File type: PDF

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Royalty Payment Options and Verification
First Name: ______________________________ Last Name:_______________________________
Address: __________________________________________________________________________
City:____________________________________ State:__________ Zip:____________________
Country:_________________________________ Phone:___________________________________
Email:___________________________________
Social Security Number (US-based citizens only):___________________________________________
US Citizen Yes No
For payment of your earned royalties, please select one of the following options:
Option 1: Use royalties towards purchase of IGI Global Publications (
Exclusive 60% Discount.
)
Option 2: Use royalties towards a standard subscription to InfoSci©-OnDemand Plus
(
Up to USD $499 of your royalties can be used.
)
Option 3: Payment by check (
Payment will be mailed to the address provided above.
)
Option 4: Payment by PayPal (
Up to 4% fee for international transfers.) Please provide valid
PayPal email address: _________________________________.
Option 5: Payment by wire transfer (
USD $25.00 fee for domestic transfers;
USD $40.00 fee
for international transfers.
)
Option 6: Donate royalties to World Forgotten Children Foundation
(www.worldforgottenchildren.org).
Name of Bank: _______________________________________________________________________
Name Enlisted on Account: _____________________________________________________________
Bank Address:________________________________________________________________________
Bank IBAN or Account Number: __________________________________________________________
Bank Routing or Swift Number: __________________________________________________________
PLEASE SIGN
Signature:_____________________________ Date:_________________________________
PLEASE FAX OR SUBMIT THIS COMPLETED DOCUMENT BY DECEMBER 2, 2019 TO:
Karin Gould
IGI Global, 701 E. Chocolate Avenue, Hershey, Pennsylvania 17033-1240,
USA Fax: 717-533-7115 Email: kgould@igi-global.com
www.igi-global.com
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Royalty Payment Form

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Completed 22 July 2020

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