Vi-RA | Payment Details

Thank you for participating in our surveys. Please do provide the following information so that we can process your honoraria payment:

Name:

Name *

Email:

email

Address:

Address *

Please choose an option to where we would need to transfer the honoraria

Radio Buttons *

Paypal

Bank Transfer

Charity

OtherOther

Please enter the details for this mode of transfer

Please enter the details on how we can make the payment

Paypal email address:

Email address for paypal transfer

Additional information if any:

Name:

Bank Name *

Bank Address:

Bank Address *

Bank Acoount Number:

Bank Account Number *

Swift code::

Swift code *

Routing number if applicable::

Routing number if applicable

IBAN number if applicable:

IBAN

Additional information if any:

Name of charity::

Name of charity *

Please do provide all information needed to make payments to your preferred charity

Charity

Payment Details