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Request for Direct Deposit (US ONLY)

In order for the ClubShop Rewards to begin, change or cease the Direct Deposit of your referral fees into your bank account. Our Accounting Team will notify you by email as to the approximate date you may expect your Direct Deposit to be effective.

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Request for Direct Deposit, update or removal of my Direct Deposit of my ClubShop Rewards commissions earned:

I, (name)______________________________________________, ID#________________________, hereby authorize Glocal Income to :

Choose One:
____________	To use the following bank account to pay my referral fees.
____________	To update my bank account information.
____________	To discontinue using my bank account to pay my referral fees. I prefer to receive my referral fees by check instead.

Note: Direct Deposits may only be sent to USA based checking/savings accounts and may only be made to accounts held in the Member's name:

Print this form. We must receive a copy or voided check, or a savings deposit ticket in order to process your request.

Bank street address:___________________________________________________________________

Bank City, State, Zip Code: _____________________________________________________________

Please select: Checking_____________ Savings_______________

VIP Signature:__________________________________________________Date:________________

VIP Email:_________________________________________________________________________

Mail form to: Clubshop Rewards, 2828 South McCall Road Suite 13, Englewood, FL 34224 or fax to 941-475-4081.