Texas Medical Cannabis NetworkSecure form

Wire Transfer / Direct Deposit Authorization

Use this form to provide your banking information so TXMMD can send payouts via wire transfer or ACH direct deposit. Submitted information is encrypted in transit, stored securely, and only visible to TMCN administrators.

Sender

Texas Medical Marijuana Doctors (TXMMD) — 5959 Richmond Ave. Ste. 200, Houston, TX 77057

Recipient (Payee) Information

Authorization

I hereby authorize Texas Medical Marijuana Doctors (TXMMD) to initiate the wire transfer / direct deposit described above. I understand that TXMMD is not responsible for delays, errors, or losses due to incorrect or incomplete information provided by the recipient.

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