Payment Details Form | Gold Coast Marathon

Personal Details

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment Details

SWIFT Code(Required)

Account Name(Required)

Bank Name(Required)

Branch(Required)

Branch Address(Required)

BSB Number(Required)

BSB Number

If applicable only

Account Number(Required)

Please verify your bank details below:

Please provide ONE of the following documents (either Bank Statement header OR Bank Deposit Slip), which must include Bank Account Name, BSB, Bank Account Number and SWIFT Code (if applicable)(Required)

Max. file size: 100 MB.

Please upload either Bank Statement header OR Bank Deposit Slip (blackout the balance amounts)

I have uploaded either Bank Statement header OR Bank Deposit Slip(Required)

YES

This is used to verify your bank account details against the information you have provided. This MUST be uploaded with your payment details form submission. Any information unable to be verified will delay your payment.

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If you have any enquiries or issues completing the form, please contact finance@emqevents.com.au

Bank Details Form

Personal Details

Payment Details

Please verify your bank details below: