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Software Form

Preferred Bank

Business Information

Business type:(check one)

Fee Summary:

Base transmission: $6

Addtl transmission fee: $5

Technology fee: $18

Document prep fee: $5

Service bureau fee: $99

This next section is for additional fees that you can add to increase YOUR revenue. This is voluntary, you do not have to take these fees if you wish not to.

Additional Fees

Bank Information

Account type: (check one)
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Disclosure statement:
By initialing and signing this form you are consenting that all ERO ADD ON fees where chosen by you and you understand whenthe payouts of each of the add-ons will be paid. You understand that all fees will be sent via direct deposit to the bank you listed on file. You also understand that all add on payouts will require a w4 form and thatyou will be issued a 1099 for tax filing purposes. Once fees are embedded they CANNOT be changed until next tax season.

Thanks for submitting!

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