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Teaching Traditional Irish Music

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Payment Selection Form

Please complete this form so that we can process payment for your work at the Virtual O’Flaherty Irish Music Retreat. Depending on your selections, additional fields may appear. Please complete everything that is shown and be sure and click the submit button at the end. Thanks!

Name
First Last
Location*
- Inside the U.S.
- Outside the U.S.
What is your preferred method of payment?*
- PayPal
- Mailed Check
- I'd like to donate my pay to the retreat.
What option for payment do you prefer?*
- Wire Transfer
- Mailed Check
May we publish your name as a donor?*
- Yes, you have my permission.
- No, I would like to remain anonymous.
Mailing Address in the U.S.*
Street Address Address Line 2 City State ZIP Code
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing address associated with your bank account. (for wiring payment)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name as Listed with Your Bank*
First Last
Name of Your Bank*
Routing Number or Sort Code*
Type of Account*
- Checking
- Savings
Bank Account Number*
Bank's SWIFT or BIC Code
Bank's IBAN*
If you have chosen to be paid through PayPal, please enter the email account you want us to use.*