Company Name Address: Attention: Tel: Fax: Email: For all correspondence except payments – Center for Technology Licensing at Cornell University Attention: Executive Director ▇▇▇ ▇▇▇▇ ▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ FAX: ▇▇▇-▇▇▇-▇▇▇▇ TEL: ▇▇▇-▇▇▇-▇▇▇▇ EMAIL: ▇▇▇-▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ Center for Technology Licensing at Cornell University ▇▇ ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇ Receiving bank name: ▇▇▇▇▇▇▇▇ Trust Co. Bank account no.: 0111000065 Bank routing (ABA) no.: ▇▇▇▇▇▇▇▇▇ SWIFT code: Bank account name: ▇▇▇▇▇▇▇▇ Cornell University Bank ACH format code: Not required Bank address: ▇.▇. ▇▇▇, ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Additional information: Reference D-5062 Agreement No.: <to be assigned> An email copy of the transaction receipt shall be sent to ▇▇▇-▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇. Licensee is responsible for all bank charges of wire transfer of funds for payments. The bank charges shall not be deducted from the total amount due to Cornell.