Media Broker Membership
DIRECT DEPOSIT REGISTRATION
Full Name
*
First
Last
Name of your Bank (for deposits)
*
Bank Account Number
*
Email Address (deposit notifications)
*
Type of Bank Account
*
Choose One
Personal Account
Business Account
Name on the Bank Account
*
Bank Routing Number
*
Type of Bank Account
*
Choose One
Checking Account
Savings 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
Activate Account Set Up