TIE-IN Information Upload

Please use the secure form below to upload your personal and payment information to CIESC in order to receive your payment from the TIE-IN program.

It can take up to 30-45 days to receive your payment. This is dependent upon the time of month that you submitted this paperwork. You will receive an automated message from our system when the payment has been sent to your bank. At that point, please allow up to 2 business days for your payment to become available.

Please note: your submission is not saved in our system! Your W-9 and ACH forms will be submitted to the CIESC finance office directly upon submission. We will not be able to retrieve or edit your submissions. You must contact the CIESC Business Manager, David Stowers, at dstowers@ciesc.org if you need to make any changes.

Personal Information

We will use this information to send a confirmation email and to verify you have submitted documentation.

Name

First Last

Payment Information

The CIESC Business Manager will use this information to add you to the financial system for payment. This information will not be saved on our website and will be sent directly to the Business Manager securely.

Address

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

SSN or EIN?(Required)

Social Security Number (SSN)(Required)

Employer Identification Number (EIN)(Required)

This field is hidden when viewing the form

SSN or EIN

Bank Account Number(Required)

Bank Routing Number(Required)

Forms

These forms will be submitted to CIESC for payment verification. These documents will NOT be stored on our servers. Only the CIESC Business Manager, David Stowers, will have access to these documents in order to send your payment.

Not sure how to edit a digital PDF file?

W-9 Form(Required)

Please download the w-9 form (click here), fill out the information, and upload here.

Accepted file types: pdf, Max. file size: 96 MB.

ACH Form(Required)

Please download the ACH form (click here), fill out the information, and upload here.

Accepted file types: pdf, Max. file size: 96 MB.

Comments

This field is for validation purposes and should be left unchanged.