Bmi Direct Deposit Authorization Form
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1Authorization Agreement for
Direct Deposit of Royalty Payments
10 Music Square East, Nashville, TN 37203
For a faster application process, please log in to your Online Services account at and select the Direct Deposit option!
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To submit a paper application, please complete and sign the Authorization Agreement for Direct Deposit of Royalty Payments.
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Each Writer or Publisher must attach a pre-printed, voided check from the bank account into which royalties are to be
deposited. Please note that checks must be drawn on a U.S. bank.
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If checks are not available for the account into which royalties are to be deposited, please attach a letter from your bank
providing the Account Name, ABA/Routing Number and Account Number.
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Please send completed form with voided check or bank letter to: BMI, Attn: Royalty Accounting Department, 10 Music Square
East, Nashville, TN 37203.
BMI Account Information
1.
2.
Writer’s Name or Name of Publishing Co.
BMI Account Number (From your Royalty Statement)
3.
Check if entering a change of address.
Social Security No. / Tax Id. No.
4.
5.
Street Address
Phone Number
6.
City
State
Zip
Email Address
Bank Account Information
7.
8.
Bank Name
Bank ABA/Routing Number
(Print the 9 digit number that appears at the bottom left of your check)
9.
9.
10.
10.
Branch Street Address
Bank Account Number
(Print your bank account number located to the right of the bank
ABA/Routing number)
City
State
Zip
Authorization
I, as the BMI Account Holder or its legally authorized representative, authorize Broadcast Music, Inc. (BMI) to electronically
deposit royalty payments due the BMI Account Holder to the specified account. If money to which the Account Holder is not
entitled is directly deposited, I authorize BMI to direct the financial institution to return said funds. This authority will remain in
effect until a new authorization is filed with BMI, or until this authorization is revoked in writing. Any dispute submitted to BMI
by the Account Holder as to a representative's legal authority to receive its funds into this account shall be deemed by BMI to be
a revocation. I understand that this direct deposit of royalties will not change BMI’s records in any way in regards to ownership
and for whom BMI reports the royalties as income to tax authorities. If you wish to assign your royalties (transfer legal
ownership) to another person or entity, please complete the BMI Royalty Assignment Verification form and submit with all
required documents.
/
Signature
Print Name of Signer
Date
If NOT the BMI Account Holder, please provide Relationship/E-mail/Phone/Address:
Relationship
Email Address
Phone Number
Street Address
City
State
Zip
Rev. 10-2014
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