CIORA Direct Deposit Form

Please complete the form below to expedite invoice payment by the CRA.

If you prefer to submit your information in writing, please fill in this form and mail it to:
Canadian Rheumatology Association
280-13300 Tecumseh Road E.
Suite 386
Tecumseh, Ontario N8N 4R8

If you have any questions, contact our Senior Bookkeeper Lisa Prout at 905 952-0698 Ext. 6.

CRA Grant ID:
Located on your funding agreement:

Contact Information

All fields in this section are required.

First Name

Last Name

Phone

Address

City

Province

Postal Code

Banking Information

All fields in this section are required.

Institution Name
Transit #

(5 digits)Institution #

(3 digits)Account #

(7 digits)

Grant Information

All fields in this section are required.

Principal Investigator(s)
Name of Institution
Grant Title
Grant Year
Internal Reference/Project ID

Please upload an image of a void cheque

Mandatory for CIORA Grant recipients

Acceptable file types are pdf, jpg, gif, or png.

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