Please screenshot this page and send it to Kate.
Information You Entered:
Name: {Name (First):1.3} {Name (Last):1.6}
Address:
{Address (Street Address):3.1}, {Address (Address Line 2):3.2}
{Address (City):3.3}, {Address (State / Province):3.4} {Address (ZIP / Postal Code):3.5}
Social Security Number: {Social Security Number:5}
Bank Name: {Bank Name:9}
Routing Number: {Routing Number:10}
Account Number: {Account Number:11}