Direct Deposit

DIRECT DEPOSIT REGISTRATION

Full Name *

First

Last

Name of your Bank (for deposits) *

Bank Account Number *

Email Address (deposit notifications) *

Type of Bank Account *

Name on the Bank Account *

Bank Routing Number *

Type of Bank Account *

Terms: I agree to a $5.00 per transaction fee and understand this transaction fee will be deducted from the broker commissions for each transaction. I can cancel this service at anytime by contacting support@4localmedia.com

Agree to Terms *

Yes

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