Lead Partner Registration Form

    Vendor Information

    Legal Name

    DBA Name

    Address

    City/State/Zip

    Country

    Vendor Contact Information

    Sales Contact Name

    Sales Contact Phone

    Sales Contact Email

    Accounts email for payment notification

    Leads Contact Name

    Leads Contact Phone

    Leads Contact Email

    Leads Vendor Email

    Vendor Banking Information - Full wire information needed

    Bank Name

    Bank City

    Country Code

    Beneficiary Legal Name

    SWIFT Code

    Routing#/BSB Code

    IBAN Number/CLABE #

    RUT#

    VAT#/TAX ID#

    IRC#

    Account Number

    Currency of Invoicing

    Signature:

    [signature* signature-384 color:#000000 backcolor:#f3f3f3 height:120 class:lprf-sig]

    All invoices must be submitted to [email protected].

    Invoices will only be accepted for completed campaigns, confirmed by the Lead Delivery Team at Lynchpin Media Ltd. This includes campaigns which are subject to pacing caps.