Receipt for Manuscript Remuneration and Mailing Address

Manuscript Number:
Recipient's E-mail Address:
Name of Recipient for Sample Copy and Manuscript Remuneration:
ID Number of Recipient for Sample Copy and Manuscript Remuneration:
Bank Account of Recipient for Manuscript Remuneration:
Phone Number of Recipient for Sample Copy and Manuscript Remuneration:
Detailed Address of Recipient for Sample Copy and Manuscript Remuneration:
Postal Code of Recipient for Sample Copy and Manuscript Remuneration:
Remarks: