welcome_ICA_W9

LET'S GET STARTED!

Admin Team ~ Lisa, Sam, Jenny & Steve

We are working on setting up your personal 4 Local Media account. As soon as you complete the paperwork below, you can begin selling any of the 4LM advertising solutions! We will help you with ongoing sales training, product education, business lead generation and 24/7 support. There are no contracts or commitments to get started with 4 Local Media.

All new MEDIA BROKERS must complete both the ICA & W9 forms before moving forward with 4 Local Media. After completing the administration forms, our admin team will provide you with the new person "ON BOARDING" training material. This agreement / partnership can be cancelled at anytime by either party. We recommended printing and reviewing the printed copies (BELOW) below before you sign and complete the agreement.

Updated: December 4th, 2014

Independent Contractor Agreeement

W9 Certification Form

Name *

First

Last

Email *

Best Cell Number *

Recieve Text Messages? *

Yes

Street Address *

Line 1

Line 2

City

State

Zip Code

Country

Electronic Signature *

Social Security Number *

ICA Page One Initials *

I agree to page 1 terms

ICA Page Two Initials *

I agree to page 2 terms.

ICA Page Three Initials *

I agree to page 3 terms

ICA Page Four Initials *

I agree to page 4 terms.

I understand that this agreement with 4 Local Media can be cancelled at anytime for any reason. If I choose to cancel my MEDIA BROKER membership, I need to email the support team and give them 10 days notice (support@4localmedia.com). All paying clients and customers will be moved to my direct manager.

Cancellation Terms *

I agree to the cancelation terms

W9 Taxpayer Identification Number (TIN)

Employer Identification Number or SSN *

Business Name (If Applicable) *

Media Broker - Partner (Referred By) *

W9 Certification (correct taxpayer identification information)

Payable Checks (Specific Name for Payments) *

Electronic Signature (U.S. Person) *

Current Date *

SUBMIT FORM HERE